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Reconstruction

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Reconstruction surgery is used to rebuild structures in the head and neck that were affected by cancer removal surgery. The goals of reconstruction surgery are:

  • Protect vital structures: This involves separating non-sterile areas—such as the mouth, throat and nose—from sterile areas such as the neck and brain. Covering important structures with healthy tissue protects them from potential life-threatening damage—the most important goal of reconstruction.
  • Restore function: Sometimes removing tumors will affect how the body works, including feeling, moving, breathing, eating and chewing. A good reconstructive surgeon will try to restore this as much as possible. Rehabilitation after reconstruction will help bring back the best function possible, working with a physical therapist, occupational therapist and speech and swallowing therapist.
  • Restore form: This means making your loved one’s appearance as close to normal as possible so he or she is not afraid to go out and live in public.

Reconstructive surgery might be done by the same surgeon who takes out the cancer. It might also be done by a reconstructive specialist. The reconstructive specialist is especially important after large and complex surgeries. Having a separate reconstructive surgeon can sometimes allow the surgery to go quicker, because for some reconstructions, both surgeons can work at once.

The reconstruction surgery can be done during the same surgery, or in some cases it might be better to wait to complete the reconstruction. Going back to complete the reconstruction is called a delayed reconstruction. The main reason to delay the reconstruction would be for the pathologist to study the tumor in detail to see if the cancer has been completely removed.

There are several types of reconstruction surgery, including:

  • Tissue replacement surgery: When the cancer is removed, tissue surrounding the tumor is also removed to make sure the surgeon has gotten all the cancer. The goal of tissue replacement surgery is to rebuild the area where the cancer was removed, either through taking skin and tissue from other areas of the body or using donated grafts.
  • Facial nerve reanimation surgery: When cancer is removed from the face, nerves may be cut or removed. Facial nerve reanimation surgery may be helpful to reconnect the cut nerves or graft nerves from other areas of the body.
  • Prosthetic reconstruction: If the cancer surgery involved taking bone or other hard structures from the head and neck, such as the nose, jaw, orbit or eye, it is possible to replace the structures with a prosthesis, an artificially made replacement such as a glass eye, a replacement jaw or nasal reconstruction.

When choosing the best option, safety (protecting vital structures), form (improving appearance) and function (making breathing, chewing and swallowing easier) are considered. In general, the simplest reconstruction that achieves all these goals is the best reconstruction.

Surgery for recurrence

Despite all the medical advances in surgery, radiation, chemotherapy and biologic medications, sometimes tumors return after treatment. This is called recurrent cancer. Recurrent cancer is different from persistent cancer.

  • Persistent cancer: This is cancer that has never gone away completely, even after finishing treatment. The cancer has stayed through treatment.
  • Recurrent cancer: This is cancer that has come back after a time when the cancer seemed to have been completely gone after treatment. Recurrent cancer is different from a new primary cancer. A new primary cancer is either a cancer that shows up more than 10 years after treatment or in a different location from the original tumor.

In both recurrent and persistent cancer, the doctors will revisit different treatment options. In many cases, recurrent or persistent cancer is treated with surgical removal. A cancer that returns or is not removed with standard treatments likely means the cancer is aggressive and is growing quickly.

Surgery for recurrent or persistent cancer is called salvage surgery. Salvage surgery is usually more extensive and more difficult than surgery to remove a cancer that has not been treated at an earlier time. This surgery is more difficult because:

  1. The cancer is fast growing, and aggressive surgery to remove the tumor is often the best chance at being cured.
  2. Scarring and inflammation after previous treatment can make salvage surgery more difficult than primary surgery.

Salvage surgery often requires more difficult reconstruction than primary surgery. This is especially true if there is a chance for radiation and/or chemotherapy as additional treatment following the salvage surgery.

The risks of complications are higher in salvage surgery than in primary surgery, but salvage surgery is often the best option to treat recurrent or persistent cancer.

Your role in reconstruction

Your loved one is facing a hard fight against the cancer, but reconstruction can bring a sense of getting back to looking and feeling normal. But remember that in most cases reconstruction will not return your loved one to looking completely as he or she did before the cancer surgery, especially if the cancer is in the jaw, mouth or face. Reconstruction may not be able to repair the voice or swallowing, so there may still be challenges in talking or eating.

Nevertheless, reconstruction is your loved one’s first step to returning to a new normal. You can help by being encouraging and loving but also by being honest and supportive about the changes your loved one is facing.

In my reconstruction, someone said to me, "You could do something over that, another thing to hide it." I said, "To be honest with you, I see it, and I see it as courage." To me, they are not marks of shame.Heather P. (orbital tumor survivor)