Reconstruction After Cancer and Trauma: Breast, Chest Wall and Penile Reconstruction

Three things: clinical examination first, to map out the deformity pattern and plan; nerve conduction study and EMG, to identify how many donor nerves or muscles are available for transfer; and MRI, to map the brachial plexus itself. Both birth-related (obstetric) and adult traumatic or oncological brachial plexus injuries are managed with this same three-part workup.

For facial procedures, growth is considered complete by around 15-16 years, so a 15-year-old's face is functionally comparable to an adult's for surgical purposes, with parental consent sufficient at that age. For the rest of the body, 17-18 is considered the optimum age, since patients are mature enough by then to properly weigh their own body image and understand the implications of the procedure.

Plastic surgery was originally developed for reconstruction, so any wound that hasn't healed in three weeks, whether traumatic, burn, or post-cancer resection, needs plastic surgery intervention and can be referred directly. Any congenital defect, a hand anomaly, cleft, or other soft tissue deformity, should also be sent directly. Cancerous skin lesions, where excision and reconstruction go together, are handled by plastic surgery too. And any leg oedema that doesn't resolve with elevation and conservative management is a specific trigger for lymphoedema referral. These are the practical trigger points to know.

Costs are considerably lower than in the Western world. Microvascular reconstructions range from roughly $6,000 to $9,000-10,000 depending on the number of procedures required and typically a 4-5 day hospital stay. Purely cosmetic procedures range from $2,000 to $7,000; a bundled "mommy makeover" package (breast reduction, liposuction and tummy tuck) is offered at a fixed $7,000.

Over the last two years, microsurgical success rate has been about 99%, with only two procedures not meeting expectations. For cosmetic procedures, outcomes depend heavily on patient expectations being realistic to begin with; when they are, success runs around 90-95%.

Bilateral latissimus dorsi muscle flaps, or a DIEP flap taking tissue from the lower abdomen, both aiming for good symmetry between the reconstructed and natural or opposite breast.

Transferring a muscle, such as the latissimus dorsi, with its nerve supply intact and reconnecting it to a motor nerve at the recipient site, so the transferred muscle can actively contract. It is used when a muscle like the biceps has been lost entirely, such as to recurrent sarcoma, to restore active movement rather than just fill the defect.