A cancer diagnosis is emotionally disturbing and physically taxing not only for the patients but also for their dear ones. All thanks to the advent of scientific discoveries and inventions, cancer treatment in the last decade spiralled by many notches, giving that much-needed solace to the patients.
One of the prime areas of medicine that goes hand-in-hand with oncology treatment is reconstructive or plastic surgery.
While surgery, chemotherapy and radiation therapy form the first line of treatment for various cancers, few patients might require reconstructive surgeries, depending on the type and severity of the condition.
An invasive surgery or the growth of the tumour itself can leave cancer patients with wounds, scars and even deformities, that might leave them demoralised and dejected for the rest of their lives and that’s where one would need the help of a plastic surgeon. Oncosurgeons addressing both cancer surgery combined with plastic surgery refer to this as oncoplastic surgery.
Reconstructive Surgery After Cancer
For many, plastic surgery is often associated with cosmetic procedures, but this niche medical speciality offers much more than that.
Also referred to as reconstructive surgeons, doctors trained in this area are responsible for repairing and restoring physical appearance that could either be external or internal. Reconstructive surgeons insert implants, perform grafting of the bone, skin, tendons for restoring the structure of diseased organ or a muscle, transplant tissues for ushering a new lease of life, confidence into survivors after successfully battling out cancer.
How Are Reconstructive Surgeries Performed?
Reconstructive or plastic surgeries are of many types and recommended mostly to those who have survived breast, head and neck, colon, small intestine, bladder cancers, etc. For instance, a breast cancer survivor would require a breast implant after undergoing mastectomy (removal of the breast due to cancer), replacement of tissues that were cut off while dissecting the tumour, correcting the deformed jawbone in case of head and neck cancer, colon resection – connecting healthy ends of intestine in the case of colon cancer, etc.
Reconstructive Surgery after Breast Cancer Treatment
Women who have undergone surgery to remove the tumour or have survived breast cancer, opt for breast reconstruction. This is often seen in the younger breast cancer survivors, and it is the most viable option after undergoing either lumpectomy or partial mastectomy.
Several techniques are used for reshaping the breast, achieving symmetry and helping the cancer survivor regain her confidence. Breast implants, revision of scars, smaller tissue flaps, fat grafting, reduction of size etc., are few procedures that are done for the desired outcome. The surgeon would consider various factors including the size and location of cancer, size of the breast and extent of surgery performed – if it was lumpectomy or mastectomy, availability of tissue, if it is needed on both breasts, if it can be matched with the size of the other breast, etc.
Breast implantation is usually done as a two-stage procedure. In the first stage, the surgeon places a tissue expander, a device under the chest muscle and is filled gradually with saline water during regular visits to the doctor.
Once the tissue has relaxed and healed, the expander is removed and replaced with an implant. The entire procedure may take up to 2 to 6 months.
Tissue reconstruction is an autologous procedure, and it is done by removing a piece of tissue called flaps, which are collected from the skin, fat, blood vessels, muscle. Most often, these flaps are collected either from the abdomen or back and they can either be pedicled or free, depending on where they were collected from.
In certain cases, the surgeon might opt for reconstructive microsurgery in which tissue is cut from its blood supply and then attached to new blood vessels in the breast area.
Reconstruction of Nipple and Areola:
A new nipple and areola are reconstructed after the chest heals completely from the previous surgery. It is done by cutting a small piece of skin from another region and then placing it on the newly reconstructed breast and shaping it. The next step involves recreating areola, which is done by grafting skin from the abdomen or groin.
Reconstructive Surgery after Head and Neck Cancer Treatment
Head and neck cancer is a term that defines the presence of malignant tumours developed in and around the throat, larynx, nose, mouth and sinuses.
Most of these cancers are squamous cell carcinomas, which originate in the flat squamous cells then later spread on to the surface structures of the head and neck. Treating cancers of the head and neck region is complex as most of our sensory organs, including eyes, nose, ears, mouth, tongue and brain are located here.
We emote, reason and express verbally, facially, and the complex nerves, bones, veins, arteries, muscles that are interconnected play a crucial role. In patients who have survived head and neck cancer, reconstructive surgery plays a crucial role in recreating the function, structure of the body parts besides making it look natural and realistic.
Reconstructive surgeons operating on the head and neck region use a broad range of advanced surgical techniques in repairing and restoring the appearance. It includes primary closure by moving the sides of affected areas, transferring tissue from another region for repair, extracting skin or cartilage from another area and sewing it to the region that needed to be repaired. In certain cases, bones and muscles from another area with veins and arteries intact, later using the tissue for replacing the tissue is also done.
Reconstructive Surgery after Colon Cancer Treatment
Colon, also known as the large intestine, large bowel absorbs nutrients, fluids, gastric contents from the food digested and processes the waste through the rectum and anus. Colorectal cancers, where malignant growth of cells is diagnosed, would require colectomy – removal of the large intestine totally, partially or in segments, and the patient would require colon resection.
It is recommended while treating either of the following colorectal cancers.
- Cecum and Ascending Colon Cancer
- Transverse Colon Cancer
- Descending Colon Cancer
- Sigmoid Cancer
- Rectal Cancer
What Is Colon Resection?
Colon resection is a full or partial removal of the large intestine. During the procedure, the surgeon removes the diseased part and reconnects, sews the healthy parts – anastomosis. It is either performed as Open Resection – with one long, single incision, through laparoscopy. This surgery is often performed by the oncosurgeon, who removes the cancer cells.
Reconstructive Surgery after Bladder Cancer Treatment
A complex invasive procedure, reconstructing bladder requires exceptional levels of expertise. Also known as neobladder reconstruction or orthotopic neobladder reconstruction, it is done after removing bladder or cystectomy, in patients diagnosed with bladder cancer.
For creating the new bladder, the surgeon first removes the cancerous bladder through an abdominal incision or through robotic surgery. Then a piece of small intestine and colon are reshaped into a sphere, which performs the role of a neobladder. It is then placed in the same location as the original urinary bladder and is attached to ureters to drain the urine out from the kidneys, while the other end is attached to the urethra.
The neobladder functions like the original urinary bladder capable of storing urine without any external bags or devices. It will take up to three to six months for the neobladder to strengthen, maintain continence and perform at its best.
Benefits of Reconstructive Surgery
Getting treated for cancer could be overwhelming, but all you need is grit, determination for fighting it out for that positive outcome. Yet at times, cancer surgery can leave the body with certain repairs and deformities that need to be addressed.
By opting for reconstructive surgery, the patient would witness great improvement both physically and mentally. It not only accelerates the quality of life but also boosts self-confidence and the sense of well-being among patients.
For many, choosing reconstructive surgery, especially in the case of breast cancers and head and neck cancers, could be life-changing at a great positive level and at HCG, we ensure it by all means!
Frequently Asked Questions
1. Who performs my reconstructive surgery?
Reconstructive surgery is usually done by the surgical oncologist, who removes the tumour. In certain cases, a plastic or cosmetic surgeon would pitch in with his or her expertise and work in close association with the rest of the team for ensuring the required outcome.
2. How long after chemo can you have reconstructive surgery?
Reconstructive surgery is usually recommended one or two months from the last chemo session. This is to ensure that all side effects of chemo have faded away and the body is getting back to normal. If needed or desired, any reconstructive surgery can be performed even years after getting cured by cancer.
3. How long does it take to recover from reconstructive surgery?
Most patients can get back to normal within 6 to 8 weeks. It, however, depends on the type of surgery performed, implants used, wound healing from within and outside.
4. What are the important questions that I should ask my doctor before my reconstructive surgery?
If you are opting for reconstructive surgery, you should certainly ask the following questions:
- Is reconstructive or plastic surgery the right option for me?
- What are the risks and benefits?
- Are there any alternatives to the procedure?
- How long does it take to perform the surgery?
- What is the complete recovery time, and how fast can you resume your normal activities?
5. Do reconstructive surgeries cause scars?
Scaring to a certain extent is imminent but an expert plastic surgeon always ensures to make those scars look less prominent. However, scars heal over time, even as your health becomes better from within.
6. Are reconstructive surgeries safe?
Like all other invasive procedures, reconstructive surgeries also carry a certain amount of risk. An expert surgeon is all you need to keep you safe and healthy even after the procedure.