Reconstructive Surgery After Cancer: Restoring Form and Function

Cancer treatment, while life-saving, often requires removal of significant amounts of tissue, leaving patients with functional deficits and altered appearance. Onco-reconstruction is a specialised branch of plastic surgery that focuses on rebuilding the body after cancer surgery. Dr. Prasanna Somvanshi, a fellowship-trained plastic surgeon in Mumbai, works alongside oncological surgeons to provide immediate and delayed reconstructive solutions that restore both form and function for cancer survivors.

Types of Onco-Reconstruction

Breast Reconstruction

Breast cancer is one of the most common cancers in Indian women. After mastectomy (removal of the breast), reconstruction can restore the breast mound, providing significant psychological and emotional benefit. Dr. Prasanna Somvanshi offers multiple breast reconstruction options:

Implant-based reconstruction: Silicone or saline implants are placed beneath the chest muscle, often preceded by tissue expander placement to gradually stretch the skin
Autologous tissue reconstruction: The patient's own tissue is used to create a new breast. Common donor sites include the abdomen (TRAM flap or DIEP flap), back (latissimus dorsi flap), and thigh (TUG flap)
Combined approach: In some cases, a combination of implant and autologous tissue provides the best result
Nipple-areola reconstruction: The final stage of breast reconstruction involves recreating the nipple and areola through local flaps and tattooing

Head and Neck Reconstruction

Head and neck cancers often require removal of portions of the jaw (mandible), tongue, palate, or facial skin. These defects significantly affect speech, swallowing, breathing, and appearance. Reconstruction in this region demands precise surgical skill and extensive microsurgical expertise. Dr. Somvanshi performs:

Fibula free flap: A section of the fibula bone (from the lower leg) with its blood supply is transferred to reconstruct the jaw, allowing subsequent dental rehabilitation
Radial forearm free flap: Thin, pliable tissue from the forearm is used to reconstruct defects of the tongue, floor of mouth, and pharynx
Anterolateral thigh (ALT) flap: This versatile flap from the thigh can be tailored for large defects of the head, neck, and oral cavity
Local and regional flaps: Pectoralis major and deltopectoral flaps remain useful for certain head and neck reconstructions

Limb Reconstruction

Bone and soft tissue cancers (sarcomas) of the limbs may require wide excision that leaves significant defects. Reconstructive surgery aims to preserve limb function and avoid amputation when possible. Techniques include muscle flaps for soft tissue coverage, bone grafts, and microsurgical free tissue transfers.

Timing: Immediate vs Delayed Reconstruction

One of the key decisions in onco-reconstruction is the timing of the procedure:

Immediate reconstruction: Performed at the same time as the cancer surgery. This approach reduces the total number of operations, provides better aesthetic outcomes, and eliminates the period of living with a defect. Dr. Prasanna Somvanshi coordinates closely with the oncological surgeon to plan simultaneous procedures
Delayed reconstruction: Performed weeks to months after cancer surgery, usually after the patient has completed radiation or chemotherapy. Delayed reconstruction is recommended when the oncological situation requires observation, when post-operative radiation is planned, or when the patient's medical condition does not permit a longer initial surgery

Free Flap Microsurgery

Many complex cancer reconstructions require free flap surgery, a technique in which tissue (skin, muscle, bone, or combinations) is completely detached from one part of the body and transferred to the defect site. The blood vessels of the flap are then reconnected to local vessels at the recipient site using microsurgical techniques under high magnification. This procedure requires specialised training, equipment, and post-operative monitoring. Dr. Somvanshi performs free flap surgeries at well-equipped centres including NH SRCC, SevenHills, and HN Reliance in Mumbai, where dedicated microsurgery setups and ICU facilities are available.

Multidisciplinary Cancer Care

Dr. Prasanna Somvanshi is an integral part of the multidisciplinary tumour board at several Mumbai hospitals. Working alongside surgical oncologists, medical oncologists, radiation oncologists, pathologists, and radiologists, he ensures that the reconstructive plan is optimised for each patient's cancer treatment protocol. This collaborative approach results in better oncological outcomes and superior reconstruction.

Recovery and Rehabilitation

Recovery from onco-reconstruction varies based on the complexity of the procedure. Free flap surgeries typically require five to seven days of hospitalisation with close monitoring of the flap's blood supply. Physical therapy and rehabilitation begin early to restore function. For head and neck patients, speech therapy and swallowing rehabilitation are essential components of the recovery process.

Cancer treatment does not have to mean living with a permanent defect. Dr. Prasanna Somvanshi's expertise in onco-reconstruction at hospitals including NH SRCC, SevenHills, Surya Hospital, HN Reliance, MRR Hospital, and Sushrusha Hospital ensures that cancer survivors in Mumbai have access to world-class reconstructive care. Contact our clinic today to discuss your reconstructive options and take the first step toward restoring your quality of life.