The FINANCIAL — Reconstructive surgery, one of the directions at Kuzanov Clinic, is a type of plastic surgery that mainly addresses reshaping structures of the body to improve function and appearance.
“The development of practical reconstructive surgery in Georgia started when micro-surgery technology was developed in reconstructive surgery,” said Professor Iva Kuzanov, Kuzanov Clinic.
“The first operation in reconstructive micro-surgery was the sewing back on of a finger in 1977. In 1988 there was the first case of a child in the Soviet Union whose hand was sewn back on. Together with Professor Natsvlishvili we formed a group which was the first to start doing implants. In that period in the Soviet Union there were only 4 cities with such a department where it was possible to sew organs or limbs back on: Moscow, Leningrad, Kiev, Tbilisi and later Minsk. By the year 1982 we had already sewed back on 1,200 fingers, hands, and later a hand and a leg. The first breast reconstruction was done in 1988 when a 21 year old girl came to Pr. Natsvlishvili. From then on the development of plastic micro surgery started,” Kuzanov said.
“Later, when the civil war started we began the implementation of aesthetic operations, the use of micro-surgery experience and technology in aesthetic surgery. First of all we managed to master corrective operations. Then we moved aesthetic surgery several steps forward. We were the first to do rhino-plastic surgery for those under general anaesthetic. We were the first to use micro-surgery technology and the open method,” Kuzanov added.
What is micro-reconstruction surgery?
“If a person lacks a body part, we can replace it with his own tissue or bone. For instance, if an oncologist has done an operation and due to cancer the patient has an amputated mandible, we can reconstruct this using tissue from his own body. We can take a muscle or piece of tissue provided it has a blood vessel, transfer it on to the needed place and cover the defect. It is necessary to have a successful blood vessel in the transplant which can be sewn into a blood vessel in the area of the operation, so that the transplanted organ remains viable,” Kuzanov declared.
“We have had several patients born without fingers, in those cases we transplanted fingers on to their hand from the foot. There is a disease which results in paralysis of the facial nerves. In such cases we have managed to restore nerves using micro-surgery rules. Moreover, we often fix large defects in bone and soft tissue,” added Kuzanov.
Kuzanov Clinic offers post-burn and post-trauma surgery. As Kuzanov said, plastic surgery is often needed in cases where after the burn period cicatrices have developed and the individual cannot unclench fingers, hands or cannot open their mouth or close their eyes.
Breast Reconstruction
“Breast reconstruction surgery is done after amputation of the breast due to cancer. Before doing breast reconstruction there are several options to be considered. First of all the woman should have the desire to reconstruct her breast, to perfect the defect. The oncologist should give the right to go ahead with the operation, ensuring that the woman is healthy and there are no metastases. Finally, the individual should be healthy and should not have any other diseases,” Kuzanov said.
There are three to four types of breast reconstruction operations available at Kuzanov Clinic.
“The breast can be created with a woman’s own tissue, which is the transfer of thoracodorsal scrap or tram-scrap. We take hypodermic cells together with a blood vessel from the stomach, which is later joined to a blood vessel in the area – so the stomach is reduced and a beautiful breast is created. If the patient is afraid of silicone prosthesis then we make the whole breast using her own tissue,” Kuzanov said.
“If the woman is not afraid of having a silicone prosthesis and has well-saved skin, an artificial breast can be created. Firstly by inserting an expander under the skin on the breast place, this later is inflated with a syringe and takes the form of a breast. By that time the skin is already stretched, we take out the expander and insert the silicone prosthesis. There is a type of silicone prosthesis though which can be inserted directly,” Kuzanov added.
The breast reconstruction surgery process lasts for 6-7 hours with a rehabilitation process of 4-5 days. However, if an expander is used first and silicone inserted later, the process can last 3-6 months.
“Each month we probably do 5 breast reconstruction operations. The price depends on the type of operation done. If the surgery is done with the woman’s own tissue then the price is 8,000-10,000 GEL. If a prosthesis is used the price is mainly evaluated by the cost of the silicone prosthesis and expander. The price of that surgery varies between 6,000-7,000 GEL,” Kuzanov declared.
Phallus Plastics
“Phallus plastic is used when a man has cancer of the phallus and after its amputation a new phallus is created. The surgery is also done after injury, or when an individual changes its gender. Moreover the operation can be done to treat impotence and when a child is born without phallus or testicles,” Kuzanov said.
Seven phallus operations have already been done because of sex changes, and five phallus reconstruction operations conducted.
Sex Change
“There are many who would like to change their sex. However at our clinic we only do surgery on true transsexuals. This is an innate disease, when sex is defined not by external organs but rather from birth, as in the body there is another sex,” said Kuzanov.
“So far, we have done seven transsexual operations, most of them a woman changing in to a man.”
“In Georgia when a patient addresses us with the will to change their sex, we first send them to the Ministry of Health, where a Bio-ethics committee for the case is created. The committee integrates different professors and includes two clerics. They discuss the application and refer the individual to two different independent psychiatric and sexology-pathologic departments.”
“Over a one year period these entities observe the patient, follow them and conduct analyses, provide consultations etc. The patient is in constant communication with therapists who later diagnose whether they are a true transsexual or not. When the individual has the final document proving that they are, they go back to the ministry which gives them the right to go ahead with the operation and we later do the surgery and change their sex.”
When the transformation is from woman to man, at the first stage the primary signs are reduced breasts, uterus and if needed one or both ovaries. After two months, a phallus is inserted and vagina closed. The rehabilitation process will take approximately half a year.
Prices
“The highest demand for reconstructive surgery operations is made up by post-burn surgery, for third and fourth stage nose operations, when we need to create a whole nose. Moreover, breast reconstruction is also highly popular among clients,” Kuznov declared.
“The most expensive reconstruction operations are where we use micro surgery such as transplantation, muscle transplantation, skin-muscle scrap transplantation, organ transplantation or creation of a new organ such as a phallus,” Kuzanov added.
The transplantation of a finger costs on average 8,000-9,000 GEL. The creation of a phallus is priced at 15,000 GEL. Transsexual operations are between 15,000-20,000 GEL. “The prices in Georgia are incomparable with Russian and foreign countries. The operation of creating a phallus in Georgia is 12,000 GEL whereas in America it is priced at 120,000 USD,” declared Kuzanov.
The income from reconstructive surgery comprises 30% of the total revenue of the clinic. As Kuzanov declared the major revenue is generated by aesthetic surgery and due to less production in the country, injury is less and consequently income from reconstructive surgery is less.
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