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Cancer Reconstruction

This is the sub-specialization of plastic surgery, dealing with the reconstruction after cancer excision.  Though the essential objective of cancer treatment is to cure cancer, the surgical treatment can affect the patient’s look, feel or capacity for socialization and also interfere to perform basic functions of speaking, chewing, swallowing, etc. This commonly occurs after Head & Neck cancer excision, and the excision of Breast cancers in females. This can likewise make self-perception issues among the patients. The best way to address it is through appropriate reconstructive plastic surgical procedures particular to the challenges they confront. Our post-excisional reconstruction helps to enhance the personal appearance and also aids to perform the basic functions mentioned above. It also boosts the patient’s psychological well-being and satisfaction of the patient thereby helping them to recover quickly. The surgeries may also help cancer patients regain their confidence, dignity, and sense of self, especially after experiencing the impacts of breast and head, and neck cancers. It has proved beyond doubt that these reconstructions improve the “quality of life” in these patients.

No, it is a reconstructive surgery to improve the function or body image. Cancer treatment can cause damage to your body that affects how it works or looks. In order to repair this damage, you may need a type of surgery called reconstructive surgery.

Reconstructive surgery is done for medical reasons. This type of surgery is usually covered by insurance, for both large and small procedures.

Surgical excision is an important modality of cancer management. This will leave a gross deformity and a functional deficit in the head and neck region. For example, a person with a tumor of the lower jaw bone, if not appropriately reconstructed, will have a grotesque deformity of the face and also loss of basic functions like chewing, speaking, and swallowing. You are most likely to need reconstructive surgery to regain your form and function.

Similarly, you might have a breast removed to treat breast cancer. The breast is a symbol of feminity and the removal of the breast will affect the body image of a person. Studies have also shown that females without breast affects them psychologically. Hence an appropriate reconstruction after cancer excision will help to regain form and function (in certain areas) thereby improving their quality of life. Reconstructive surgery can help repair the changes to your body from your cancer surgery.

The majority of reconstructive surgery is done at the same time during the cancer excision. This has the advantage of single anesthesia and surgery. Technically reconstructive surgery is easier when done in a single stage. Moreover, an appropriate reconstruction after cancer surgery will have a positive impact on the patient and eventually the recovery. The patient need not undergo the suffering of lack of form and function before undergoing reconstruction at a later date. Also, a single hospitalization has a financial advantage. In certain situations, depending on the patient medical conditions, nature of the tumor, preference of the patient, and need for adjuvant treatment which may distort the reconstruction – the reconstructive surgery might be done later.

Reconstructive surgery is generally done by a qualified plastic surgeon, preferably trained in such complex reconstructive methods. The majority of cancer reconstructive surgeries involve microsurgery and last for 6-8 hours. Generally, the cancer management team includes a plastic surgeon.

Reconstructive surgeons may perform skin, muscle, fat bone, or tendon grafts, use implants to replace a muscle or a damaged body part, or transplant bone or tissue to replace an area that has been removed.
Reconstructive surgery often uses tissue from one area of your body to repair another area. The medical term for this type of surgery is “autologous reconstruction.” This means that the tissue used in the surgery comes from your own body. It is a common type of reconstructive surgery.

This can be done using

  • Tissues from the region near the defect are called the local/regional flaps pedicled flaps
  • Tissues from different areas are harvested with their blood vessel and then the tissue is used for reconstruction. This tissue gets its blood supply by joining the blood vessels to other blood vessels near the defect using fine sutures thinner than the hair, under microscope magnification. This is also called “microvascular” surgery.

For example, head and neck surgery might change the shape of your jawbone. This is reconstructed using bone from your leg to repair your jaw. This can restore the shape of your jaw and help it work normally

Other types of reconstructive surgeries include:

Artificial materials are called implants. this is generally used for breast, skull bones, certain facial bones, and joints.

No, reconstructive surgery will not affect your recovery period. To help reduce symptoms, enable faster recovery, and manage the quality of life after surgery, patients are offered supportive care therapies, including pain management, nutrition therapy, and oncology rehabilitation. The time you need to recover depends on the type of cancer surgery and the type of reconstruction. Generally, the recovery period is not much affected because of reconstruction. In fact, a good reconstruction will help the patient recover faster and early return to routine. For reconstruction, the tissues may be harvested from other parts of the body. hence patient might have additional pain/immobilization of the donor area. Pain medications and rest that will be advised for the cancer excision surgery will be sufficient for the overall healing irrespective of reconstruction.

In case of any infection/flap failure, then the adjuvant treatment will be prolonged. But the chances of such Events are rare and less than 5 %.

No, the reconstruction is though done to give the best form and function, the shape and appearance after surgery will not be totally normal. The tissue taken from other areas will have different colours, textures, thicknesses, and hair. Both cancer treatment and reconstructive surgery can change how you look and feel. But without reconstruction, the appearance will be very much abnormal as also the function. The process of using a patient’s own tissue with healthy blood flow helps promote healing, reduce scarring and create a more natural-appearing reconstruction.

The most significant complication after reconstructive surgery is partial/total flap failure in which there is loss of the reconstructed tissue. But the chances of such occurrence are quite rare, approximately 2-5 %. It again depends upon the patient’s condition, the co-morbid factors like diabetes & hypertension, previous radiation treatment, and the complexity of reconstruction.

The area from where the tissue is taken for reconstruction is called the donor site. If the tissue taken is little then the donor site wound will be sutured primarily or in case it is larger,  then the area will be covered with a skin graft from the thigh. There will be some contour deformity/minimal functional loss in the donor area. The donor site is generally chosen in such a way that it gives the appropriate tissue and also has the least donor site morbidity for the patient. For example for jaw bone reconstruction, a supporting bone will be taken from the leg. Such patients will not have problems walking.

In breast reconstruction, skin and fat are harvested from the lower abdomen. This removes the excess skin in the lower abdomen and provides the patient with a tummy tuck as part of the reconstruction.

Head and neck cancer microsurgery

Plastic surgeons can reconstruct areas affected by head and neck cancer with reconstructive microsurgery. It may be possible to reconstruct the nose, tongue, or throat using tissues from other areas of the body, such as the thigh, abdomen, or forearm. The lower jawbone (mandible) may be reconstructed using the smaller bone from the lower leg (fibula). For patients with facial paralysis secondary to tumor removal, transfer of a small muscle from the inner thigh may be performed to restore a smile.

Oncoplastic breast conservation surgery

Oncoplastic breast conservation surgery adds an aesthetic approach to lumpectomy by reshaping or rebuilding the breast to maintain a natural look and feel. This type of surgery is intended to remove cancer while preventing excessive scarring following surgery and radiation. Plastic surgery techniques such as breast lift, breast reduction, or local flaps are commonly used in these types of operations. Surgery on the other breast may also be performed to create or improve symmetry. In addition to preserving a healthy physical appearance, oncoplastic breast conservation surgery may also help women heal emotionally after cancer surgery—restoring feelings of confidence, self-esteem, and femininity.

Reconstructive microsurgery for breast cancer

Using a woman’s own tissue is a common approach to building a new breast. The reconstructed breast may look and feel more natural. One option is an operation called the deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction. The procedure removes skin and fat from the lower abdomen while preserving the muscle. Women who undergo DIEP flap breast reconstruction may experience less pain and shorter recovery times than other techniques that do not preserve the muscle. By reducing damage to the donor site, abdominal wall integrity and strength may also be maintained.

Yes, definitely. These surgeries are improving the patient body image and function. Hence they are covered under insurance – both private and government.

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