Reconstruction Following Cancer

At Mount Sinai Beth Israel, the Division of Plastic Surgery works closely with world-class cancer surgeons in various specialties to offer our patients top-quality reconstructive surgery following treatment for cancer. Reconstructive surgery is frequently an essential part of cancer treatment and is often performed to improve both function and appearance.
Our reconstructive surgeons work closely with cancer surgeons in developing a plan of care, and our acclaimed microsurgery program serves the broad reconstructive needs of the Continuum Cancer Centers of New York. The Division’s skill in microsurgical free tissue transfer is routinely employed in complex areas of reconstruction, including head and neck reconstruction and breast reconstruction.

Breast Reconstruction
Head and Neck Reconstruction
Skin Cancer and Reconstruction

Breast Reconstruction
Advances in breast reconstruction techniques have dramatically improved the options for breast cancer treatment. At Beth Israel, our renowned reconstructive plastic surgeons are involved with breast cancer cases from the beginning, working as a member of the team that evaluates the oncologic and reconstructive options of breast cancer patients and develops a strategy that is most appropriate for that individual.

Most mastectomy patients are appropriate candidates for breast reconstruction. Of course, the decision is a highly personal one, to be reached by the woman, her family, and her medical team. A patient can start talking about reconstruction with her physician as soon as she receives her cancer diagnosis.

While breast reconstruction doesn’t need to be done immediately following surgery, there are several benefits to performing immediate reconstruction— the patient will have to face just one operation, one hospitalization, and one recuperation. Plus, there are certain procedures that allow for a better reconstruction that plastic surgeons can perform only at the time of a mastectomy. Perhaps most importantly, studies have shown that immediate reconstruction helps women get through this traumatic time more easily. There are also reasons to wait, however. If you aren’t comfortable with making the decision right away, you don’t want more surgery, or if the reconstruction calls for a more complicated procedure, then you may want to postpone reconstruction.

The next decision the woman and her physician must make is what kind of reconstruction to have—implants, or autogeneous, which uses her own tissue. An autogeneous reconstruction offers a single operation and a more natural result, while implant reconstruction requires two smaller procedures. For the implant method, the surgeon will typically insert a balloon expander under the skin and chest muscle after a mastectomy. Then over a period of several weeks, a salt-water solution will be added to gradually fill this expander and stretch the skin. After the expander is removed, a breast implant is inserted. Occasionally, if there is no need for tissue expansion, the surgeon can simply insert an implant following the mastectomy.

If a patient desires a single stage breast mound reconstruction, but lacks enough autogenous tissue to create a full breast, muscle and skin from the back can be rotated around to the breast region to cover the implant in one operation. This makes tissue expansion unnecessary and therefore saves the patient the extra operation to remove the expander and place the implant. The muscle and skin from the back also provide a softer, more natural reconstruction since the tissues are not stretched over the impant like the expanded tissues.

Breast implants can be filled with either silicone gel or a salt-water solution known as saline. However, due to concerns that there isn’t enough information demonstrating the safety of silicone implants, the Food & Drug Administration has ruled that silicone gel-filled implants can only be available through approved studies. Beth Israel is participating in one such study—the McGhan Medical Corporation Silicone Breast Implant Trial.

For autogeneous reconstruction, a flap is created from skin, fat, and muscle from other areas of the body, such as the abdomen. Sometimes the surgeon leaves the tissue attached to its original site, and tunnels the flap beneath the skin to the chest. This can create the breast mound or a pocket for an implant. Beth Israel’s plastic surgeons also specialize in the free tissue flap technique, in which the surgeon takes skin and fat from another part of the body, transplants it to the chest, and reconnects its blood vessels to ones in the chest or armpit. This operation requires a skilled microvascular surgeon. Both types of flap reconstruction are more complex than skin expansion, but generally create a more natural result.

Head and Neck Reconstruction

Head and neck cancer refers to a wide range of cancers that affect a variety of locations, including the face, eyes, ears, nose, lips, jaw, throat, tongue, cheek and more. Because of their location, these cancers can cause defects that are both functional and cosmetic, and the patients’ reconstructive needs can present the surgeon with numerous challenges. The complex anatomy of this area means that functions such as speech, swallowing and airway protection can be affected. At Beth Israel, our reconstructive surgeons’ goal is to minimize loss of function while maintaining as normal an appearance as possible.

At one time, reconstruction could only fill the defect, and the cure for head and neck cancers was sometimes considered worse than the disease. However, refinements in microsurgical and craniofacial techniques now enable the plastic surgeon to perform reconstruction on patients with even the most advanced type of tumors. Frequently, the plastic surgeon works in conjunction with a surgical oncologist. With microsurgical techniques, the plastic surgeon can repair large and severe defects, allowing the cancer surgeon to be even more aggressive in the resection of the tumor.

At Beth Israel, plastic surgeons specializing in head and neck reconstruction work closely with head and neck surgeons and radiation oncologists at the Continuum Cancer Centers of New York to develop surgical treatment plans. Our dedication to state-of-the-art reconstructive care can be seen in our formation of an integrated Medical, Extirpative, and Reconstructive Head and Neck Cancer Institute.

Skin Cancer and Reconstruction

Since about 80 percent of skin cancers appear on highly visible areas of the face, head, or neck, they can be extremely disfiguring. That’s why the skills of a highly qualified plastic surgeon are essential. At Beth Israel’s Division of Plastic Surgery, our plastic surgeons specialize in removing malignant and benign skin growths in a way that both removes the cancer and maintains function and as normal a cosmetic appearance as possible.

The type of procedure required and the cosmetic results depend on the size and severity of the skin cancer. For small cancers, the surgery may be a simple and quick excision with a scalpel that leaves a barely noticeable scar. For larger cancers, surgeons may use curettage and desiccation—scraping out the cancer with an electric current that controls bleeding and destroys the remaining cancer cells—which may leave a larger, white scar. More severe cancers can result in permanent changes in structures such as the nose, lip, or ear. It may be necessary to use skin flaps taken from other areas of the body reconstruct the affected area.

While our plastic surgeons are highly qualified to diagnose and treat skin cancers, they can also be involved if you use a dermatologist for your initial treatment. Using reconstructive techniques that range from simple scar revision to complex tissue flaps, our plastic surgery team can repair the damaged tissue and restore function and a more pleasing appearance to skin cancer patients.