Reconstructive microsurgery: What patients should know

Sometimes our surgeons must perform life-altering surgeries to remove cancer. And, in many cases, cancer surgeries have the potential to dramatically change a patient’s physical appearance or lifestyle. But through reconstructive microsurgery, our plastic surgeons are often able to help patients return to their normal appearance or lifestyle.

Microsurgery allows surgeons to perform procedures that were once impossible, and they’re using these tools to improve surgery every day. In fact, each year, MD Anderson’s 21 plastic surgeons perform more than 1,000 microsurgeries to reconstruct patients from head to toe. Many of these surgeries are breast reconstruction, when surgeons use the patient’s tissue to create new breasts after a mastectomy. But surgeons may also use this technique for reconstructing other parts of the body.  

To learn more about microsurgery, we spoke with plastic surgeons Alexander Mericli, M.D., and Carrie Chu, M.D. Here’s what they had to say.

What is microsurgery?

Microsurgery gets its name because it refers to surgery performed using a microscope. During microsurgery, we use precise microsurgical instruments that allow us to reconnect very small blood vessels, nerves and lymphatic vessels with very tiny stitches – some thinner than a hair and difficult to see with the human eye.

We often use microsurgery in conjunction with other surgeries, such as tumor removal and reconstruction, to reconstruct complicated areas that otherwise wouldn’t be possible.

Among other things, we use microsurgery to:

• reconstruct breast cancer patients’ breasts using tissue from their abdomen or other parts of their bodies
• rebuild jaws using a bone from the leg, shoulder, arm or hip, or reconstruct tongues with skin and fat from the arm or leg
• use muscles from other parts of the body to rebuild leg muscles so patients with orthopedic cancers can walk again
• repair skin damaged by radiation therapy

Are there any downsides to microsurgery?

Considering the precise, detail-oriented nature of reconstructive microsurgery, such surgeries are often lengthy and may take an entire day. To help minimize the length of these complex surgeries, MD Anderson plastic surgeons may work together to reduce surgery time.

In the days following the surgery, your care teams will closely monitor the surgical site, so a three- to seven-day hospital stay is required. During your stay, our care teams will make sure that the relocated tissue is adapting well.  

What advice do you have for patients considering or preparing for reconstructive microsurgery?

If you have the right doctor, microsurgery doesn’t have to be scary. Be sure to pick a plastic surgeon who is experienced with microsurgery and performs these highly specialized surgeries often. At MD Anderson, for instance, all of our plastic surgeons have undergone specialty training in microsurgical reconstruction and are experts in this subspecialty.

What should patients ask their surgeons before reconstructive microsurgery?

Ask your plastic surgeon lots of questions. Make sure you discuss how the surgery will affect your daily life, both right after the surgery and in the years to come. (For example, if your surgeon uses tissue from your abdomen, you may experience a lift and tighter skin there, but you also will have limited use of that area until you recover fully.)

You may need physical therapy following surgery, so discuss what rehabilitation programs you’ll need and how to adjust your expectations following surgery.

And be sure to ask what side effects you may experience after surgery. These will vary depending on the what part(s) of the body the surgery is performed on.  

In 2015, MD Anderson plastic surgeon Jesse Selber, M.D., led the world’s first skull and scalp transplant. More recently, he led a team in performing a large soft tissue transplant, when a patient received a large piece of skin from her identical twin sister to help repair skin on her own back damaged by radiation. What’s next when it comes to innovation in microsurgery?

Now, surgeons are using microsurgery to help patients with lymphedema, a common cancer side effect that leads to swelling. During a lymphovenous bypass, surgeons improve the flow of fluid by redirecting it. This is made possible by a high-powered microscope that lets surgeons disconnect and reconnect vessels less than half a millimeter in size. The stitches are so small that they’re translucent and float on air.

Surgeons are also researching the use of 3-D imaging to develop microsurgical reconstruction plans before surgery, as well as looking for ways to reconstruct nerves that would restore sensation after surgeries like breast reconstruction.

Microsurgery gives plastic surgeons the freedom to use their creativity to best serve our patients. There’s no telling what the future may bring.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.