Millard and Gillies’ 7th Commandment of Plastic Surgery: “Thou Shalt Provide Thyself with a Lifeboat”

by Or Friedman, MD
Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical, affiliated with the Sackler Faculty of Medicine
Tel-Aviv University, Tel-Aviv, Israel

Millard reported on his mentor Sir Harold Gillies’ “ten commandments of plastic surgery” in 1950, codifying a set of principles encompassing practical, technical, and ethical axioms to guide the reconstructive efforts of plastic surgeons [1] (Table 1).

Rohrich et al., revisited those commandments and described their practical application during our daily practice [2]. We would like to highlight each principle with a resource from PRS Global Open that demonstrates its use.

“It is not the will to win that matters—everyone has that. It is the will to prepare to win that matters.” -Bear Bryant

7. Thou shalt provide thyself with a lifeboat.

A lot has been written and said about pre-op planning and preparation. Also, we do seem to pick up on this recurring theme in the “ten commandments.” However, the seventh commandment takes the concept a step further and considers the possibility of failure despite meticulous planning and execution.

Using the Venous Pectoral Branch from the Thoracoacromial System as a Lifeboat in Autologous Breast Reconstruction” by Dr. Michael Tarakji et al. demonstrates the application of the commandment at the very core of our specialty.

The authors review the different “lifeboats” at the disposal of the reconstructive breast surgeon and describe the use of the Thoracoacromial system in a challenging case. While the concept is not a new one, the case report serves as an excellent reminder of the importance of considering the normal and potentially disrupted anatomy in our patients.

Preparing for the different eventualities, most of all intraoperative complications is a unique aspect of our reconstructive work and an essential motivator for colleagues from other specialties to continually seek our advice.

PRS Global Open case reports are a great source for challenging plastic surgery cases and breaking them down to the “ten commandments” may help consolidate our “plastic” approach and reasoning.


  1. Millard DR Jr. Plastic peregrinations. Plast Reconstr Surg (1946) 1950;5:26–53.
  2. Rohrich RJ, Timberlake AT, Afrooz PN. Revisiting the Fundamental Operative Principles of Plastic Surgery. Plast Reconstr Surg. 2017 Dec;140(6):1315-1318.3.
  3. Tarakji M, Bartow M, Dupin C, Tessler O. Using the Venous Pectoral Branch from the Thoracoacromial System as a Lifeboat in Autologous Breast Reconstruction. Plastic and Reconstructive Surgery Global Open. 2017 June;5(6).

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