The portrayal of plastic surgery is often misleading, its practitioners tell Iva Pocock
It seems plastic surgeons have an image problem. Endless media focus on Botox and boob jobs, as well as the modern-day meaning of plastic, mean the profession is often poorly understood, say Irish surgeons.
"Some people come along and say where's the plastic," says Dr Patricia Eadie, a plastic surgeon who works in three Dublin hospitals - St James's, Our Lady's and St Luke's.
"They think that after a skin graft they're going to get a piece of plastic to make it all look good."
The misunderstanding can be explained, she says, by looking at the etymology of plastic - the Greek word plastikos, meaning to form.
"Most people think we are doing face-lifts, tummy tucks and boob jobs all day because that's what they read in magazines," says Eamon Beausang, another plastic surgeon in St James's hospital.
In reality, the 16 plastic surgeons who work in public practice in Irish hospitals are not re-forming their patients for purely cosmetic reasons.
"Plastic surgeons in Ireland traditionally do surgery for trauma, cancer and congenital abnormalities and a small amount of cosmetic or aesthetic work," says Jack Kelly, one of three plastic surgeons at University College Hospital Galway.
"Trauma injuries constitute about 60-70 per cent of the work in every plastic surgery unit in the country," says Kelly. The main plastic surgery units are in Dublin, Galway and Cork.
In St James's 60 per cent of our work is trauma-based and 90 per cent of that is hand or upper arm injuries, says Dr Eadie, who shuns the traditional Irish and British convention whereby surgeons go by Mr or Ms. It dates from the days when surgeons weren't medical doctors, but butchers, she says.
On average, St James's unit, with six plastic surgeons, gets three or four new referrals of patients with acute hand injuries every day. They come from the Dublin region, as well as the midlands, north east and south east.
"There are different categories - industrial accidents, home accidents where someone may have slammed their hand in a door, and knife and glass accidents at the weekends, quite a lot of which are alcohol related," says Dr Eadie.
There's a similar pattern in Galway, says Kelly. "Saturday nights tend to be very busy, as well as Christmas and bank holidays. It tends to be alcohol-related and a male phenomenon."
Kelly says there's also a seasonal pattern to traumatic injuries with a significant peak in the summer months in keeping with patients who are outdoors and more active, especially children. In particular injuries from lawnmowers go up in the summer time, as do the numbers of overseas patients, he says.
St James's also deals with a lot of leg injuries from road accidents, says Dr Eadie, as well as gunshot wounds both accidental or intentional.
While there is no data to show whether such patients are more common, she remembers treating criminals nick-named the Monk and the Whale for gunshot wounds. "We had a security guy in here the other day who was in a post office raid."
Plastic surgeons also perform a reasonable amount of skin cancer operations, says Mr Kelly, adding that it is the most common form of cancer.
Plastic surgeons in St James's also get involved with head and neck cancers.
"The ENT [ear, nose and throat] surgeons will remove the tumours and then we reconstruct using tissue from elsewhere and use microsurgical means of trying to give back their function and form. They are fairly long and involved operations of up to eight to 10 hours."
She operates two whole days per week, from 8.30am to 5pm, if things run to plan. "But by the time people are transferred up here putting back fingers or arms is usually in the middle of the night. So once a month I'd spend the night here."
Recontruction following breast cancer constitutes a significant amount of some plastic surgeons' workload, especially as techniques are now better and more predictable.
"Reconstruction is now offered to anyone under 60," says Dr Eadie who does a fair amount of breast surgery, including breast reductions, enlargements and equalisation.
Reconstruction techniques depend on three factors: the size of the breast you are trying to match, how much tissue is left and whether the patient has had radiotherapy.
"If it's a small area and there has been no radiotherapy it may need only a small implant, either of silicone or saline. If there is a certain amount of skin but not enough skin stretch we may use an expander.
"If there is not enough skin we may take it from somewhere else such as the back or tummy. If it's the back it will have no bulk but if from the tummy you will probably get enough."
More and more Dr Eadie is finding that her female patients have done a lot of reading about breast reconstruction before they come to her.
While less than 20 per cent of breast cancer patients request reconstruction, Mr Kelly predicts that the number of women choosing it will increase. This is partly due to services such as breast check which is leading to more people having surgery in the early stages of cancer.
The main congenital disorders dealt with by plastic surgeons are cleft lip and palates.
"More of the complex cranio-facial plastic surgery is done in Temple Street by Mr Michael Earley," says Kelly.
In Our Lady's Hospital for Sick Children, Dr Eadie deals with children born with abnormalities such as syndactyly (webbed hands), or missing fingers. However, children who have been badly burned are treated in the national burns unit in St James's hospital, which is also where the worst adult burns are treated. There is a smaller burns unit in Cork University Hospital and a unit is due to open in Galway soon.
Cosmetic surgery is virtually non-existent within the public system because such patients, who are very low priority, would be on a waiting list forever, says Beausang. "It's not because there's a specific ban on breast enlargements in public practice."
Instead cosmetic work is carried out by many of these public appointment surgeons in their private clinics.
Kelly does breast reductions which can benefit patients' quality of life enormously, he says. Breast augmentation, mainly of those who have had small breasts all their lives, also form part of this workload.
The lure of lucrative private cosmetic surgery is potentially a future problem in terms of keeping plastic surgeons in the public sector, says Kelly. He claims demand for cosmetic surgery is not great at the moment but acknowledges that it is increasing. "I think there's a mystical kind of belief that a plastic surgeon holds the key to the elixir of youth, which isn't the case."