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Plastic Surgery Enhances Form and Function

Network - Winter 2010

By Mary Brolley

Mention “plastic surgery,” and the response might be a smirk or a dismissive nod. Often associated with procedures to erase the signs of age, smooth the ravages of the sun or perfect body parts, plastic surgery is usually voluntary — elective — and is rarely covered by health insurance.

Geoffrey Robb, M.D.

But Geoffrey Robb, M.D., professor and chair of the Department of Plastic Surgery at M. D. Anderson, wants you to know there’s much more to the discipline than cosmetic procedures. In fact, reconstructive plastic surgery has emerged as an essential element of many patients’ cancer treatments, and plastic surgeons have become ever more respected members of the medical team.

Trained in microsurgery at the University of Pittsburgh School of Medicine, Robb came to M. D. Anderson in the early 1990s. He recalls that as the institution moved to a more collaborative way of working, “We plastic surgeons asked for ‘a place at the table’ to help plan treatment.”

Robb is emphatic about how crucial reconstructive plastic surgery is to many patients’ treatments. The plastic surgeon, he explains, often has to provide the tissue to protect the bone as it heals. For example, if the patient has a cancer that requires the removal of his or her jawbone, the plastic surgeon might carve out a section of the fibula, a bone on the lower leg, to mold into the jaw.

Because both procedures require special care to heal, the plastic surgeon’s delicate stitching of the patient’s own vascular tissue is crucial.

Essential to cancer care

Their colleagues appreciate the contributions of plastic surgeons to successful outcomes for patients. Raphael Pollock, M.D., Ph.D., head of the Division of Surgery, notes that many multi-team surgeries in M. D. Anderson’s operating rooms involve plastic surgeons. “They remarkably extend what we can do,” he says.

Robb leads a team of 16 plastic surgeons, the largest and most productive group devoted to cancer in the world. Surgeons are natural planners and executors, he says, and input from plastic surgeons is crucial in making decisions about the timing and sequence of other surgical procedures. Also, their expertise in vascular surgery makes them sought after by oncologic surgeons who want to make sure they remove all the cancer.

“Because of plastic surgery, the oncologic surgeon can be aggressive — not concerned about the extent of the operation — to get all the cancer,” Robb says. “Then we work to restore the body contours and maintain or restore functional elements, such as the restoration of a disfigured or abnormal body part. And often we need to address loss of function caused by the cancer and treatment.”

Plastic surgeons are also experts in microsurgery, using a surgical microscope to aid in the careful removal and reapplication of a patient’s own vascular tissue to help restore normal contours and function.

Innovations changing the standard of care

Robb has challenged members of his team to go beyond the status quo and try to solve stubborn problems in their specialties. In response, they have made major strides in patient care.

One plastic surgeon pioneered a post-mastectomy approach that uses tissue expanders to develop and maintain natural breast contours before and after a patient undergoes radiation therapy. Others developed the integration of digital 3-D imaging to construct surgical models of the mid- and lower face that has revolutionized reconstructive strategies. And they have changed the standard of care in the surgical management of esophageal cancer by replacing affected areas of the throat with leg tissue.

Plastic surgery offers benefits to survivors

Robb says plastic surgery has much to offer cancer patients — and survivors. Some of the side effects of cancer treatment, such as neuropathy, a disorder of the nerves that causes tingling, numbness or pain, and lymphedema, abnormal swelling of a limb, may be addressed by reconstructive plastic surgery.

In fact, David Chang, M.D., professor and director of the Julie Kyte Center for Reconstructive Surgery, has developed a promising, minimally invasive procedure called lymphaticovenular bypass that essentially reroutes the built-up lymphatic fluid and eases the miseries of lymphedema.

Robb is pleased by how far plastic surgery has come at M. D. Anderson and how integrated his team is in the strategic processes of treating each patient.

“Every time we get a reconstruction case, it’s different from every other case,” he notes. “We try for an equilibrium between function and aesthetics.”

© 2015 The University of Texas MD Anderson Cancer Center