Reconstructive surgery helps cancer patients reshape their self-image
Patients with breast, head, neck or other cancers often have difficult choices to make. Removing tumors may be an essential component of their treatment plan, and key to their recovery. Ridding the body of cancer is, after all, the primary goal of cancer treatment. But it’s not the only goal. For many patients, another question arises: How can I feel whole again? Cancer operations that change how patients look, feel or function may have significant implications on their quality of life after surgery.
That’s where reconstructive plastic surgeons can play a major role, offering options to help patients—both men and women—regain their confidence, dignity and sense of self. Post-surgical reconstruction is making a difference in the lives of a wide array of cancer patients, especially those with breast, head and neck cancers. And many of these patients are being helped by the very doctors involved in their cancer treatment. Reconstructive plastic surgeons who work exclusively in cancer care are well-equipped to anticipate cancer patients’ needs, to understand the unique challenges they face and to offer a full spectrum of reconstruction options.
Rebuilding the breast
Breast reconstruction has become a common choice for many women after a mastectomy of one or both breasts. In 2014, U.S. surgeons performed 102,200 breast cancer reconstruction surgeries, 7 percent more than the year before, according to the American Society of Plastic Surgeons. The numbers show how much has changed since the 1990s, when breast reconstruction was in its infancy, leaving few options for women who craved a more normal appearance after a mastectomy. Today’s reconstructive plastic surgeons have a number of ways to help such patients.
It is important for patients who undergo mastectomy to understand that breast reconstruction is a well-planned process that typically requires more than one surgery, says Dr. Aaron Pelletier, a Plastic and Reconstructive Surgeon at our Chicago-area hospital. Several factors are considered in formulating a unique plan for each woman, determining both type and timing of reconstruction. These factors include a woman’s overall health, weight, breast size and whether other conventional cancer treatments, such as radiation therapy, are necessary.
Many women are able to begin the reconstructive process at the same time that their mastectomies are performed. This procedure, known as immediate reconstruction, can help breast cancer patients cope with body image issues they may face after surgery. “It’s very powerful if a woman can wake up with a breast mound as opposed to no breast at all,” says Dr. Rola Eid, Medical Director of Plastic and Reconstructive Surgery at our hospital in Tulsa. For many reasons, though, immediate reconstruction is not safe or appropriate for some patients, and their doctors may recommend delaying the procedure to protect the patients’ best interests.
Whether delayed or immediate, breast reconstruction options are available to patients, and they typically fall into two categories: implant-based reconstruction, which uses a gel implant with or without a tissue expander; and autologous reconstruction, which uses the patient’s own tissue in creating what is referred to as a flap. The implant-based procedure, the most common type of reconstruction, often involves placing a tissue expander in the breast at the time of mastectomy, then gradually filling it with fluid to stretch the skin. After several weeks, the expanded skin creates a pocket for the implant, which is inserted during a subsequent operation.
Compared to implant-based reconstruction, autologous procedures are more involved, and may require a longer recovery period. But because they use the patient’s own tissue, they may yield more natural-looking results and, therefore, are increasingly popular among patients. They are also typically recommended for women who have undergone radiation therapy. One popular autologous technique is the deep inferior epigastric perforator (DIEP) flap, where skin and fat is removed from the lower abdomen, preserving the muscles, and transferred to the chest, where blood supply is reconnected to the body. “One of the most sophisticated forms of breast reconstruction involves molding excess abdominal tissue into the shape of a breast and making sure this tissue survives on tiny blood vessels,” says Dr. Daniel Liu, a Plastic and Reconstructive Surgeon at our hospital outside Chicago.
With autologous fat grafting, surgeons can refine the look and feel of the breast, first by using liposuction to remove fat cells from one part of the body. Then they inject the fat into the breast, sculpting the tissue into shape. Fat grafting, which is also known as lipofilling or fat transfer, helps surgeons fine-tune the breast’s shape, symmetry or contour. Another way to achieve a more natural look is with acellular dermal matrix (ADM), a type of biological mesh that has greatly improved the process of implant-based reconstruction. Cancer Treatment Centers of America® (CTCA) surgeons commonly use ADM to support the lower pole and reconstruct the natural fold below the breast.
Helping head and neck cancer patients
Mastectomy patients, of course, are not the only cancer survivors struggling with self-image issues after cancer removal surgeries. Operations to treat head and neck cancer can leave scars and defects that affect the way some patients feel about themselves. The changes to the neck and head can also cause everyday challenges, such as trouble speaking, eating and interacting with others. Patients who had surgery for cancer of the mouth, throat or neck have multiple options to rebuild their features. Tissue from the abdomen, forearm or thigh may be used to reconstruct the nose, tongue or throat. And with 3D modeling, surgeons can map out a craniofacial repair by trying out patient-specific jaw positions with precise anatomical cutting guides.
Then there’s the free flap surgery, a precise technique in the field of microvascular surgery that transplants tissue from one area to another by reconnecting tiny blood vessels “less than four millimeters in diameter, with a suture thinner than a hair,” says Dr. Bradley Mons, Otolaryngologist and Head, Neck and Microvascular Reconstructive Surgeon at our Tulsa hospital. He uses a harvesting technique that allows the free flaps, once healed, to take on the form and function of the tissues they replaced.
Dr. Mons, who is board certified in both otolaryngology and facial plastic surgery, prefers treating diseases of the head and neck with a two-pronged approach. First, he removes the cancer, and then, whenever possible and appropriate, he rebuilds parts of the jaw, nose, sinuses or tongue in the same operation, often with living bone grafts from the patient. For example, in treating stage I sinus cancer patient Margery Gadd, Dr. Mons removed her sinuses and part of her upper jaw along with the cancer. With his training to perform two surgeries in one, he also rebuilt her facial features in the same operation.
Learn more about how Dr. Mons helped other patients battling head and neck cancer, and learn more about how reconstructive microsurgery is used to help patients.