Surgical oncology

Reconstructive surgery

Cancer itself or cancer treatments may affect the way your body works or looks. When this happens, Seattle Cancer Care Alliance (SCCA) and the UW Center for Reconstructive Surgery provide expert solutions. UW Medicine’s reconstructive plastic surgeons help to improve function, change appearance or both for patients who get cancer care through SCCA.

We offer a wide range of methods to help you look and feel restored. As always, we fit your care to your exact case as well as your goals, preferences and values. Reconstructive procedures for SCCA patients take place at UW Medical Center – Montlake and UW Medical Center – Northwest.

What is reconstructive surgery?

For people with cancer, reconstructive surgery is done to correct, improve or change function or appearance when cancer or its treatment affects the body.

Reconstructive surgery is different from cosmetic surgery. The goal is to restore function or form that was altered. Cosmetic surgery is done when a person chooses to change the look of a healthy body part that is “normal” or typical. It is elective surgery.

“We recognize that we are meeting you during a stressful period in your life. We provide empathetic care and have in-depth discussions about reconstructive options that are tailored to your specific needs. We really get to know you well and develop a long-term relationship with you during the process.”

— Shannon M. Colohan, MD, reconstructive plastic surgeon

Diseases and procedures

UW Medicine reconstructive surgeons treat people with many types of cancer or related conditions, including these:

Breast cancer

There are many options for breast reconstruction for people with breast cancer who are interested. If you are having a mastectomy, we offer both implants (using synthetic materials) and natural tissue procedures (using tissue from your own body). We also offer options to preserve or restore your breast shape after a lumpectomy.

Based on your wishes and your treatment needs, you may be able to have reconstruction during the surgery to remove the cancer. Or you may be able to wait to have reconstruction later. Read more about breast cancer treatment and breast reconstruction.

Colorectal cancer

During surgery to treat colon or rectal cancer, some patients need reconstruction of the pelvis or perineum. The options depend on the exact surgery being done for the cancer. If needed, our skilled reconstruction team does procedures to cover and close the perineal area or place tissue in the pelvis. We do this using tissue from another part of your body (flap reconstruction), often the abdomen or thigh.

In most cases, our colorectal and reconstructive surgeons work together to remove the cancer and do the reconstruction during the same surgery. Read more about colon cancer treatment and rectal cancer treatment.

perineum The area of the body between the anus and the vulva in females, and between the anus and the scrotum in males.

Lymphedema

Lymphedema is a type of swelling that can happen when surgery or radiation therapy affects lymph flow. Our reconstructive surgeons offer advanced methods to prevent or treat it. Preventive options include:

Axillary reverse mapping (ARM)
Microsurgery to restore lymph flow (known as LYMPHA), which is done at the same time as lymph nodes are removed

We also offer methods to treat lymphedema after it starts. These include:

Lymphovenous bypass (also called lymphaticovenular anastomosis, or LVA)
Microsurgical transfer of lymph nodes to the affected area (vascularized lymph node transfer, or VLNT)

Read more about lymphedema.

Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Axillary reverse mapping A method to locate lymph vessels by injecting dye during surgery. This helps surgeons preserve the lymph vessels. LYMPHA Surgery to connect small lymph vessels to blood vessels so lymph has a path to drain into the bloodstream. LYMPHA stands for lymphatic microsurgical preventive healing approach.

Melanoma, Merkel cell carcinoma and other skin cancers

The same surgeon who removes skin cancer may be able to close the area by bringing the edges around the wound together. If the wound is too large or the cancer went too deep for this approach, our reconstructive surgeons offer more options. These include:

Closing the wound with neighboring skin that is turned into place (local tissue rearrangement)
Using skin from another part of your body (skin grafting)
Using skin plus other tissue from another body area (free-flap reconstruction)

Read more about treatment for melanoma, Merkel cell carcinoma and skin cancer.

Sarcoma

Sarcoma may affect soft tissues, like skin and muscles, as well as bones. If your sarcoma surgeon needs to take out soft tissue or bone to remove a tumor, our reconstructive surgeons can help restore the area. They may use nearby soft tissue (local tissue rearrangement) or tissue from another part of your body (flap reconstruction). When bones are involved, UW Medicine orthopedic surgeons offer options like bone transplants, joint replacements and metal implants. Read more about sarcoma treatment.

Vulvar cancer

Cancer of the vulva is often a type of skin cancer. In many cases, the gynecologic oncologist who removes the tumor is also able to close the area. When the cancer surgery is more extensive, a reconstructive surgeon is often involved. Often, they use skin from the same region of the body and rearrange it to make a new surface for the labia. If more tissue is needed, the surgeon may use tissue from your abdomen or thigh. Read more about vulvar cancer treatment.

Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs.

Some UW Medicine surgeons who remove tumors also provide reconstruction, when needed, for several other cancer types, including these:

Bladder cancer — to create a new system to collect and drain urine if surgeons remove your bladder
Head and neck cancer — to replace skin, bone, muscle or other tissue to restore your appearance or important functions, like swallowing and speaking
Lung cancer — to rebuild part of your chest if surgeons need to remove a tumor in the chest wall

First appointment

Your first appointment to discuss reconstructive surgery is a time for you and your surgery team to meet. You will talk about your diagnosis and how reconstructive surgery may fit into your treatment plan. Typically, SCCA patients have already seen other members of their SCCA care team and know the plan for treating their cancer before coming to see us about reconstructive surgery. We adapt the process and timing to meet your needs.

Your first appointment is also a time for the reconstructive surgery team to start getting to know you personally. This helps us tailor our recommendations to you based on your treatment plan, preferences and goals. Together, you and your care team decide what to do next.

We encourage everyone to bring a family member or friend to their first appointment (and any future visits).

Meet the Care Team from UW Center for Reconstructive Surgery

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

What to expect

First appointments usually last up to one hour. Here is what you can expect to happen.

Talking about what makes you a candidate

Reconstructive surgery may be an important step toward restoring the way your body works or looks. It may make a difference in your health, comfort and ability to do what you need and want to do. In some cases, reconstruction is less about restoring function and more about restoring appearance. The way your body looks may affect your sense of well-being or how you view yourself. These are all valid reasons to think about having reconstruction.

Based on your exact cancer, reconstruction may be optional (elective) or necessary. For example, people with breast cancer may choose to have breast reconstruction or not. However, if cancer surgery exposes important structures (like blood vessels, nerves, organs or bones), you will need reconstruction. Your surgeon will talk with you about the aspects of your cancer or your treatment that make you a candidate — whether the focus is on function, appearance or both.

Discussing your reconstruction options

Based on the details of your disease and the treatments you have had or plan to have, your surgeon will explain your options. One approach may clearly be the best fit in cases like yours. Sometimes there is more than one possible approach. We will tailor your options to your unique case and your wishes. During your visit, your surgeon will talk with you about:

What we recommend for you and why
What the results may be like
How reconstruction fits in with your other care
When reconstruction will happen
What you can do to get the best outcome
How our team supports you throughout the process

Getting to know you

These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs, values and preferences. We want to get to know you so we understand the best way to care for you. For example, it is helpful for us to know:

How much detail you would like about the procedures and what to expect
What your goals are for reconstruction
What matters most to you about the process of getting care
Who is available to support and take care of you when you need help
What concerns you have about deciding whether to have reconstruction

Answering your questions

Throughout your first appointment (and after), we are here to answer your questions. We want to help you understand as much as you wish to about your disease, your treatment and how care happens at SCCA and UW Medicine. To get you started, here are some questions you might want to ask:

What are the benefits and risks of reconstruction?
How soon would I have reconstruction?
What do you expect my recovery to be like?
What are the results likely to be in my case?
What happens if I have a complication?

We strongly encourage you to bring a friend or family member with you. They can help keep track of your questions and the information that your team gives you.

Deciding what is next

Before you leave, we make sure you know what is going to happen next and how you can reach us if you have questions later. We will schedule your future visits or make sure you know when and how to schedule.

If you would like more time to think before deciding about reconstruction, we understand. Ask your team to explain how soon you need to decide.

In some cases, reconstruction is done at the same time as surgery to remove the cancer. In other cases, it can be done weeks, months or years later. Your team will talk with you about the timeline in your case.

Research

At SCCA and UW Medicine, our physicians and researchers are always asking how we can make treatment better and reduce side effects. This is why we do research, including clinical trials. Through these studies, we are able to offer you therapies that are not available everywhere.

Our experts have done research on a range of topics that relate to reconstructive surgery, such as:

How to reduce the risk of infection
How to improve long-term results
How to refine methods and make immediate reconstruction possible

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.