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Cancer Reconstruction | Procedures | Dr Vikas Kakkar

CANCER RECONSTRUCTION


Breast Reconstruction

What is breast reconstruction?

Breast reconstruction is to restore a breast to near a normal shape, size and appearance following mastectomy (breast removal in cancer surgery) by various plastic surgery procedures.

Why do you need Breast reconstruction?

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.

A new breast creation can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.



Who is the ideal candidate for Breast reconstruction?

Breast reconstruction is a good option for you if:

You are psychologically and physically ready to cope well with your diagnosis and treatment
You do not have other medical illnesses that may impair healing
You have a realistic expectation for restoring your breast and body image
As breast reconstruction single or multi stage procedure:
It can be done at the same time as mastectomy,
It can be delayed until you heal from mastectomy and recover from any additional cancer treatments



What are the risks involved and safety required in this surgery?

The general risks of breast reconstruction include, like normal surgical risk as bleeding, infection, poor healing of incisions, and anaesthesia risks but there is no life threatening risk. There are procedure specific risks like:
Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.

The use of silicone implants carries the risk of breast firmness (capsular contracture) and implant rupture.
Breast implants do not impair breast health.


How to procede for breast reconstruction surgery?

Routine blood test, medical evaluation/ Pre anaesthesia checkup
Stop smoking well in advance of surgery
Avoid medicines those can cause increase bleeding like aspirin, anti-inflammatory drugs and herbal supplements .



Which anaesthesia given in Breast reconstruction?

It is done under general anaesthesia and follow up cases like nipple areola reconstruction and fat grafting can be done under LA or sedation.


What are the various types of procedure for breast reconstruction?

There are various Flap techniques to reposition a woman’s own muscle, fat and skin to create or cover the breast mound.

SGAP/IGAP flap techniques which do not use muscle but transport tissue to the chest from buttock as free flap.

TRAM flap uses muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and tunnelled up through the chest wall, or be completely detached, and reconnected to chest blood vessels as free flap to form into a breast mound.
DIEAP flap uses fat and skin from woman’s lower abdomen based on perforator of deep inferior epigastric artery. And ellipse of tissue taken from lower tummy and reshaped to build new breast.

TUG (Transverse Upper Gracilis) flap uses thigh skin, fat and muscle and transferred to chest as free tissue transfer, resulting same time nipple and areola reconstruction.

Alatissimus dorsi flapuses muscle, fat and skin from the back transferred to the mastectomy site and leaving blood supply intact. It can be combined with silicone implant.
Tissue expansion is two stage procedure which stretches healthy skin to provide coverage for a breast implant.

Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a lengthier process. It requires multiple OPD visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander with a permanent silicone implant.

Nipple areola reconstruction is the last stage of breast reconstruction, can be completed through a variety of specialized techniques.


Skin Cancers

Skin cancers are cancers that arise from the skin. They are maily raises due to the development of abnormal cells that have the ability to invade or spread to other parts of the body.
There are three main types: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two together along with a number of less common skin cancers are known as nonmelanoma skin cancer (NMSC).
Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin,that may be shiny with small blood vessel running over it or may present as a raised area with an ulcer. Squamous-cell cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer.
Melanomas are the most aggressive signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.


Head And Neck Reconstruction

As a restorative surgery, a neck lift does not change your basic fundamental appearance and cannot stop the aging process.

A neck lift can only be performed surgically; non-surgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a neck lift become suitable and compliment the results of surgery.

Considerations & goals with neck lift surgery:

Reduces or eliminates a “turkey neck” by removing excess, sagging skin
Smoothes out wrinkles and creases throughout the neck
Improves the appearance of vertical neck bands
Results are long-lasting and will age naturally with a patient
Can be combined with a facelift for more comprehensive facial rejuvenation


Jaw Reconstruction

Sometimes jaw problems may require much more than orthodontic treatment. Jaw surgery, also known and popularly known as orthognathic surgery, can be a great choice for moderate to severe jaw issues. Oral and Maxillofacial Surgeons (OMS) are especially trained in orthognathic surgery that can dramatically improve your chewing, speaking, breathing, and is in the process enhance a patient’s appearance.

Factors to be considered before surgery
• If you are considering orthognathic surgery, here are some important things to know.

Why You May Need It?
Most conditions that require corrective surgery are the result of abnormal growth of the jaws as they develop. These conditions are often inherited. Other less common causes are facial injury or arthritis of the jaw joints.



Orthognathic surgery may be indicated for the following conditions:
Difficulty biting, chewing or swallowing food

-Excessive wear or breakdown of teeth
-Chronic jaw or jaw joint pain caused by TMJ (temporomandibular joint problem) or other jaw problems
-Improve “gummy” smiles, where the lips don’t fully close and show large areas of the gums or “toothless” smiles, where the lips cover all of the teeth
-Facial imbalance, including underbites, overbites, crossbites, and deficient chins
-Sleep apnea

What to Expect?
Jaw surgery can be performed on the upper jaw, lower jaw or both. It is best to perform the surgery after growth stops, usually ages 13 to 15 for females and 16 to 18 for males. Jaw surgery usually can be performed entirely inside your mouth, so no facial scars show.
Once your jaws are properly aligned, screws and bone plates secure the bones into their new position. In some cases, extra bone may be added to the jaw. In this case, we transfer the bone from your hip, leg or rib and secure it with temporary wires.

Surgery can take place in an in-patient or outpatient setting, depending on the procedure required. Facial swelling, while variable, is common and increases for a couple of days. More subtle changes in your appearance will continue for up to a year. For this reason, our students generally choose to have the surgery during school vacations. For adults, one to three weeks is usually required before returning to work.

Jaw surgery can enhance your comfort, appearance, and improve your overall health. We are here to answer any questions you have. Please make an appointment for a consultation so we can review the potential of this life changing treatment with you!


Cheek Reconstruction

Cheek reconstruction the cheek constitutes the facial periphery and plays a key role in the maintenance of oral competence and mastication, the facial manifestation of human emotion, and the support of neighboring primary structures. The repair of cheek defects seeks to achieve both aesthetic and functional ends that must be carefully considered by the reconstructive surgeon. The most common causes of acquired cheek defects include tumors, burns, trauma, whereas congenital-abnormalities in cheek contour may be due to facial clefts, vascular anomalies, or facial wasting syndromes.


Tongue Reconstruction

Tongue carcinomas are the most common oral carcinomas. The current treatment strategies for tongue carcinomas are mainly surgery-based comprehensive therapies.
• There are many methods that are very accurate for defects after ablative surgery or for small or mid-sized defects, including primary closure or local flaps.
• For large defects, however, reconstruction remains one of the most challenging problems. The tongue plays a key role in speech and deglutition; therefore the ideal reconstructive method should provide not only satisfactory structural cosmesis, but also good restoration of function.

The Anterolateral thigh (ALT) free flap was first described by Song et al. in 1984. Wei et al. reported that the failure rate of the ALT free flap was less than 2%, and they concluded that the ALT flap could replace most other flaps for soft tissue, because of the availability of a long pedicle with a suitable vessel diameter, versatility in design, and low donor site morbidity. The ALT flap has since become a standard technique for reconstructive microsurgery, with many reports about its application for reconstruction of the head and neck, upper and lower extremities, and the trunk and breast, but few reports exist on its use in tongue reconstruction.

Here, we present our experience with the ALT flap for defects of the tongue and floor of the mouth, highlighting the reasons for its versatility and benefits, and presenting analyses of the functional results.


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  • 564, B-Block, Ranjit Avenue, Amritsar
  • +91 98151-31355, 0183-2500955
  • clinickakkar@gmail.com

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