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Plastic Surgery: A Component in the Comprehensive Care of Cancer Patients

Plastic Surgery: A Component in the Comprehensive Care of Cancer Patients

Plastic surgical reconstruction
extends the capabilities of surgical and radiation therapy for cancer patients. Resection defects that are
large, involve functional structures, aesthetically sensitive areas, and/or are
at increased risk for wound healing complications are successfully reconstructed
with a wide variety of techniques. Cancer and the complications of cancer
treatment can involve virtually any area of the body, and to address every
potential circumstance, the breadth of oncologic reconstruction must be
extensive. A multidisciplinary team approach is the optimal method of cancer
treatment, and plastic surgical reconstruction has become a critical component
of that treatment, with the ability to restore form and function to the involved
areas.

It is with great pleasure that I have the opportunity to reflect on the
article by Drs. Hasen, Few, and Fine, who nicely summarize some of the commonly
performed oncologic reconstructive procedures. The authors are to be commended
for their succinct and simplified overview of the complex decision-making and
execution involved in oncologic reconstruction.

Choosing a Procedure

Decisions about breast reconstruction should be individualized, based on
input from both the surgeon and patient. It is crucial that there be open and
accurate communication with the medical oncologist, breast surgeon, and
radiation therapist, who will influence the potential reconstructive options and
ultimate procedure selected.

As stated in the article, tissue expander/implant reconstruction can be used
for patients who are uncertain of the type of reconstruction they desire. This
option is the least invasive, reversible, maintains the shape of the breast skin
envelope, does not involve surgery outside the breast area, and usually can be
converted to an alternative type of reconstruction in the future, if desired.
Although this strategy "burns no bridges," I would strongly emphasize
the benefit of choosing and performing the reconstructive option best suited for
the patient as the primary procedure, to reduce the potential need for
additional operative procedures.

Every attempt should be made to educate the patient about each available
option, providing a detailed comparison of the risks, complications, expected
outcomes, and recovery considerations. Additional sources of information that
have been helpful include written literature, diagrams, photographs, videos, and
discussions with patients who have undergone each procedure (ie, those who have
had positive and negative experiences).

I am much more reluctant than the authors to use tissue expander/implant
reconstruction in patients who have had or will receive chest-wall irradiation,
particularly if an autologous tissue reconstructive option is available. The
functional and aesthetic outcome is often compromised and, as mentioned, the
complication rates are considerably higher.

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