What is reconstructive surgery?

Quick Answer
Surgery to rebuild areas lost as a result of cancer or cancer treatment, as well as injury.
Expert Answers
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Cancers treated: Many different 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 can also be performed for cosmetic reasons. When it is done for cosmetic reasons, it is usually performed to restore a more symmetrical appearance, to reduce the signs left by cancer and cancer treatment, and to improve self-esteem.

Patient preparation: Patient preparation depends in large part on the procedure that is being done. Preparation before surgery generally includes not eating or drinking any fluids for a certain number of 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 health care team will provide the patient with the necessary information about what to do, and what not to do, in the hours, days, and weeks before the surgery. In some cases, mental health support may be suggested for before the surgery, as well as afterward, if the surgery is going to make a great 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 desires of the patient, the patient’s health level, body type, and other factors.

Most reconstructive surgery involves using skin, fat, muscle, or tissue from one area of the body and moving it to another location 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 possible 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 the removal of cancerous tissue is closed using sutures. This generally 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 will usually be 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 for some reason, then the surgeon may decide to use a pedicle flap, a section of tissue that is removed from one area but left attached to the blood supply in that area. The flap is anchored to the recipient site with its original source of blood 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 then moved to the recipient site and connected. This is generally a longer and 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 that 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 type of procedure and the area of the surgery. Usually there will be a hospital stay of short to moderate duration after the procedure, although some more minor procedures may be performed on an outpatient basis. Healing will take varying lengths of time depending on the type of procedure used and the location on the body of the surgery. For most reconstructive surgeries, as with most surgeries, it will take a few weeks or longer for the patient to return to their normal level of activity.

Some reconstructive surgeries can be followed up at a later time, generally after the wound has mostly or completely healed, with additional cosmetic procedures. For example, after breast reconstruction, the nipple can be reconstructed at a later time, after the breast itself has healed. Additionally, tattooing of the nipple and areole can be done at a later time to try 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 who has questions about the surgeon’s training, qualifications, or experience with the type of 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 that are done under general anesthesia have the risks associated with general anesthesia, 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 to be 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 associated risks. For example, there is a small risk of breast implant rupture associated with breast reconstruction. Individuals should talk carefully with their surgeons and any other health care providers to discuss all the possible risks associated with the specific procedure that they are considering before making a final decision.

Results: Reconstructive surgery is often very successful. It is important, however, for the individual to talk to his or her surgeon about what realistic expectations for the procedure should be, as the results of reconstructive surgery can vary. Nearly all procedures will result in some scarring, which will usually fade with time but never disappears completely. Reconstructive surgeries often cannot change some things with which the individual was unhappy before the cancer. In many cases, the procedure is a large improvement, but the reconstruction is not a 100 percent perfect match because of a number of factors. 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. For breast reconstruction, the reconstructed breast is often a close match, but not a perfect match, of the other breast. The more realistic the expectations of the reconstructive procedure, the more likely the individual is to be satisfied with the results.

Bibliography

Berry, Daniel J., and Scott P. Steinmann. Adult Reconstruction. Philadelphia: Lippincott, 2007. Print.

Kryger, Zol B., and Mark Sisco, eds. Practical Plastic Surgery. Austin: Landes Bioscience, 2007. Print.

Park, Stephen S., et al. Facial Plastic Surgery: The Essential Guide. New York: Thieme, 2005. Print.

Sarwer, David B., et al., eds. Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical, and Ethical Perspectives. Philadelphia: Lippincott, 2006. Print.

Serletti, Joseph, et al. Current Reconstructive Surgery. New York: McGraw, 2013. Print.

Steligo, Kathy. The Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. 3rd ed. Baltimore: Johns Hopkins UP, 2012. Print.

Thorne, Charles H., et al., eds. Grabb and Smith's Plastic Surgery. 7th ed. Philadelphia: Lippincott, 2014. Print.

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