Integrated Cancer Care

Panorama Centre For Surgical Oncology

Dr Christiaan Gildenhuys

Dr. Gildenhuys is our resident Plastic and Reconstructive surgeon.  He qualified as a general surgeon before completing further specialization in Plastic and Reconstructive surgery at the University of Stellenbosch. This gives him in a unique insight into the surgical and reconstructive aspects of therapy.

He has been in full time private practice since 2016 forming an integral part of the multidisciplinary team of spacialists.

He feels strongly that every patient should have the opportunity to have reconstructive options discussed as part of their treatment plan from the start. Several different teqniques exist and everyone should be informed about the options.

His aim is for natural looking and functional  results without interfering with the oncology treatment.

Timing of reconstruction

Reconstruction at the same time as cancer surgery is often an advantage because it combines two surgeries and two recoveries into one.

It’s biggest advantage is that it offers an opportunity to use the remaining breast tissue in the reconstruction – this tissue is often lost if a mastectomy is done without prior involvement and planning with a plastic surgeon.

Because of this, early involvement and planning with a plastic surgeon is important as it provides more options for reconstruction and ultimately a better result and quicker recovery.

Reconstructive options

There are many options available for breast reconstruction, and each surgical option has unique advantages and disadvantages to the individual that should be explained and discussed with the patient to allow for an informed decision.

The timing is the first factor that should be considered, but it has become the standard of care to allow breast reconstruction during the same procedure as the surgery for cancer.

The method for reconstruction is based on the type of cancer surgery you will have as well as the unique preferences of the patient. Based on theses preferences, a reconstructive option that uses your own tissue (autologous), an implant (prosthetic) or a combination of these two options can be used to perform your reconstruction.

It is important that reconstructive surgery does not influence or delay your cancer treatment, as this remains the priority during your treatment journey. There are many options available to you that will allow for sound simultaneous cancer treatment and reconstruction which offers a favorable and efficient outcome for patients undergoing cancer surgery. These reconstructive options are also covered by medical aids in South Africa if motivated appropriately.

It is important that all options are explained to you early in the treatment, as understanding your personal reconstructive goal is important. It is also important to discuss alternative options so that you make the correct choice and understand why other reconstructive options are not appropriate in your situation.

Planning your reconstruction from the start of your surgical journey is essential to achieving the best result in the most efficient timeframe.

reconstructive surgery

What is reconstructive surgery?

Reconstructive surgery is restoration surgery. It’s goal is to repair the surgical site following a cancer surgery, and aims to restore the natural form and function of the area affected by surgery.

Am I a candidate for reconstruction?

Almost all patients have the option of reconstructive procedures and it is common practice to perform this at the same time as the primary cancer operation. This approach has the benefit of a single procedure and recovery instead of a prolonged reconstructive path which is common with delayed reconstruction.

You should insist on discussion of your reconstructive options and a consultation with a plastic surgeon before a surgical and treatment plan is finalized. This is important to help you make a well informed decision regarding your own treatment plan, as some surgical options may be lost if prior planning isn’t done.

Medical aids allow for reconstruction following surgery for cancer, and an experienced surgeon will be able to offer you reconstructive options which are covered by your medical aid.

Reconstructive surgery at the time of cancer surgery is an option that is available to every patient undergoing surgery for cancer, and early and appropriate planning is important to achieve the best possible outcome within an acceptable time frame.

Breast conservation

Mastectomy is not the standard of care when treating breast cancer. There are certain circumstances where a mastectomy is appropriate, but often removal of the tumor alone is appropriate and adequate treatment. This treatment strategy in known as breast conservation.

Breast conservation under the appropriate conditions is a well researched and proven treatment option in breast cancer surgery, and does not pose disadvantages in the correct setting.

Tumour excision alone allows the breast surgeon to remove the tumour using a similar technique to breast reduction and includes a similar procedure on the healthy breast to allow for symmetry. Your own breast tissue is the best form of reconstruction in the appropriate setting, and allows for a rapid and simple single stage operation and recovery.

If you are scheduled to have a mastectomy, ask your surgeon why a mastectomy is required and ask for a second opinion if you are not satisfied. Routine mastectomy is not the standard of care for breast cancer.

Panorama Centre for Surgical Oncology