As Rwanda advances in general healthcare, some medical specialties that were once perceived alien and less relevant to us have now gained ground and the impact on people’s health is increasingly being realised.

Last week, more than 30 patients received free plastic surgery services in Bushenge Hospital, fully sponsored by Operation Smile. Some of the surgeries performed included repair of cleft lips and palates, treatment of burn injuries and the deformities from the burns, surgery for skin cancers, among others. Rwandan Plastic surgery trainees, and other teams were also trained during the outreach.

It is a common misunderstanding among most people, either in Rwanda or elsewhere, where plastic surgery is assumed a medical specialty that deals exclusively with improving people’s beauty.  This indeed isn’t entirely wrong as either aesthetic surgeries or non-surgical procedures which aim at improving the appearance of people’s bodies and structures is a branch of plastic surgery specialty, usually just termed as aesthetics.  

However, the field of plastic surgery is a lot wider than just beauty medicine and more especially in developing countries. Plastic surgery also greatly deals with restoration of body structures to as normal as it can possibly be achieved after physical traumatic injuries, such as road traffic accidents, burn injuries, and all types of wounds with their long-term complications, such as bad scars, contractures (hardening of a scar that usually cause inability to fully use the affected joint). Fires, hot water, gas explosion, and other forms of burn accidents are very common in Rwanda, and this leads to a huge burden of burn injuries and their complications, both immediate and late complications. 

Cancers of the skin are also managed in plastic surgery, and more especially when these are in the faces where there is an aesthetic concern after surgical management. These types of skin cancers have over the years shown an increasing incidence in Africa than before, with some patients presenting at advanced stages.  

Orofacial cleft conditions, including cleft lips and cleft palates where babies are born with slits in the lips (as split lips) and openings in the roof of the oral cavity at birth are deliberating conditions to the newborns, yet easily managed. These babies are usually unable to breastfeed properly, hence, easily suffer from malnutrition and its related complications, such as failure to thrive and growth retardation. They are also usually faced with poor speech development, as well as ear infections if not well and timely managed. It is not uncommon to have parents of children with cleft conditions stigmatised by societies, and at times a mother abandoned for having a baby with such a condition. Cleft surgeries to correct these conditions restore hope to these children, as well as rebuild their families and re-instate them into society. These conditions, among other anomalies that babies can be born with, are managed by plastic surgeons whenever they are available. This is not to mention that some other non-plastic surgeons with added training in cleft surgeries can do these cleft surgeries with good outcomes, especially in settings with a limited number of plastic surgeons.

There are some women that develop excessively large breasts which can cause functional impairments in their daily activities. These usually develop back and shoulder pain, failure to find bras, inability to do exercises or even skin infections under the breast creases. The surgery to transform these breasts to a bearable size is done by plastic surgeons, and this is in fact a therapeutic surgery rather than aesthetic. 

Rwanda has advanced in breast cancer management and has shifted from removing all the affected breasts to just removal of the cancerous tissues to preserve the rest of the breast, with reconstruction of the remaining breast tissues to maintain the woman’s breast shape. This is mainly attributed to availability of radiation therapy treatment, as well as skilled surgeons to preserve and reconstruct the breasts.

Plastic surgery is in general a wide surgical specialty beyond just beauty medicine and has a far reaching physical, and social impact on people and the communities. It boosts self-confidence and gives a chance to be re-integrated in society. 

Dr Ian Shyaka Resident, Plastic Surgery Rwanda Military Hospital

iangashugi@gmail.com