Reconstructive surgery

ALSO KNOWN AS: Plastic surgery, cosmetic surgery

DEFINITION: Reconstructive surgery is surgery to rebuild areas lost as a result of cancer or cancer treatment, as well as injury.

Cancers treated: Many types of cancers, especially breast cancer and skin cancers

Why performed: Reconstructive surgery may be performed to correct problems caused by cancer or cancer treatment. It is often performed to restore better functioning to the affected area. It is also performed for cosmetic reasons. When done for cosmetic reasons, it usually restores a more symmetrical appearance, reduces signs left by cancer and cancer treatment, and improves self-esteem.

Patient preparation: Patient preparation largely depends on the chosen procedure. Surgery preparation generally includes not eating or drinking fluids for several hours before the surgery, stopping certain medications such as blood thinners, or beginning to take medications such as antibiotics to help prevent infection. The surgeon and the surgeon’s healthcare team provide the patient with the necessary information about what to do and avoid before surgery. Sometimes, mental health support may be suggested before and after surgery if the surgery is going to make a significant change in the individual’s appearance.

Steps of the procedure: The steps of reconstructive surgery will vary depending on the type of surgery. For many types of surgery, there will be more than one option, and the surgeon will decide which one to use based on the patient's desires, health level, body type, and other factors.

Most reconstructive surgery involves using skin, fat, muscle, or tissue from one body area and moving it to another to reconstruct the desired area. Sometimes, prosthetics are used in addition to the material from another area of the patient’s body. For example, one method of breast reconstruction involves using some tissue from the patient in addition to an implant made of saline or silicone.

Five main types of procedures are used during cancer treatment and afterward. The first type is a simple closure of the wound area, in which the wound created by removing cancerous tissue is closed using sutures. This allows for healing with minimal scarring and a coloration that matches the surrounding skin.

If the area removed is too large to be closed using sutures, then a skin graft might be used. In this procedure, skin is removed from another site on the patient’s body and is placed over the area that needs to be closed. A donor site is usually selected for the best possible match of coloration to the recipient area and minimal visibility.

When more than just skin is desired, a local flap may be used. The surgeon will take skin and tissue from an area next to the site of the wound and move it over the wound. The flap remains connected to its original surroundings by veins and arteries.

If a local flap is not available or appropriate, the surgeon may decide to use a pedicle flap, a section of tissue removed from one area but left attached to the blood supply in that area. The flap is anchored to the recipient site, and its source of blood is still intact.

The other alternative is to use a free flap. A free flap is completely removed from the donor site, including the severing of all arteries and veins. The flap is moved to the recipient site and connected. This is generally a longer, more complex surgery than a local or pedicle flap because the surgery team must use microsurgery to connect the flap to the adjacent area so blood can flow in and out of the tissue, keeping it alive.

After the procedure: The aftercare for reconstructive surgery will vary depending on the procedure type and area. Usually, there will be a short to moderate hospital stay after the procedure, although some more minor procedures may be performed on an outpatient basis. Healing will take varying lengths depending on the surgery's type and location. As with most surgeries, reconstructive surgeries will take a few weeks or longer for the patient to return to their average activity level.

Some reconstructive surgeries can be followed up later, generally after the wound has mostly or completely healed, with additional cosmetic procedures. For example, after breast reconstruction, the nipple can be reconstructed later, after the breast itself has healed. Additionally, tattooing the nipple and areole can be done later to match the existing breast as nearly as possible.

Risks: There are risks associated with any kind of surgical procedure. The risks of reconstructive surgery are generally low when the procedure is performed by a certified reconstructive surgeon who is experienced in the procedure. A patient with questions about the surgeon’s training, qualifications, or experience with the procedure being considered should never hesitate to ask.

The risks associated with reconstructive surgery are generally the same as those associated with any other type of surgery, including excessive bleeding, infection, pooling of blood beneath the skin, bruising, and problems with wound healing. Procedures performed under general anesthesia have inherent risks, including changes in blood pressure or heart rhythm. Complications from general anesthesia are generally rare, although certain diseases and conditions can increase these risks.

Reconstructive surgery is generally considered relatively low risk for individuals who are otherwise in reasonably good health. Certain diseases and conditions can interfere with the healing process or can cause an increased risk of complications. Individuals who have high blood pressure, diabetes, or immune system problems or who have conditions that affect the blood’s ability to clot may be at increased risk of complications. Individuals who smoke may be required to quit smoking for a few months before the surgery to decrease the likelihood of side effects or complications and to increase the body’s ability to heal effectively. This kind of requirement generally depends on the specific surgeon who is doing the procedure. In general, individuals who smoke have a more difficult time healing completely after surgery and may have increased visibility of scars.

In addition to the risks associated with any type of surgery, each reconstructive procedure may have its own risks. For example, there is a small risk of breast implant rupture associated with breast reconstruction. Individuals should talk carefully with their surgeons and other healthcare providers to discuss the possible risks associated with the specific procedure they are considering before making a final decision.

Results: Reconstructive surgery is often very successful. However, the individual must talk to their surgeon about realistic expectations for the procedure, as reconstructive surgery results vary. Nearly all procedures result in some scarring, which usually fades with time but never disappears entirely. Reconstructive surgeries often cannot change some things with which the individual was unhappy before the cancer. The procedure is often a large improvement, but the reconstruction is not a 100 percent perfect match. In cases of skin grafts, the area from which the skin is taken is usually not a perfect match in terms of pigmentation and tone for the area to which it is moved. The reconstructed breast is often a close but imperfect match of the other breast for breast reconstruction. The more realistic the expectations of the reconstructive procedure, the more likely the individual is to be satisfied with the results.

Bibliography

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