Cancer patients sometimes take a double hit: Not only have they recently received diagnosis of a life-threatening disease, but often their only chance of survival involves surgery that takes something vital away from them—a breast, a knee, even an esophagus or genitals. But that loss doesn’t necessarily have to be forever, says Justin Sacks, director of oncological reconstruction within the Department of Plastic and Reconstructive Surgery at Johns Hopkins. He and his team work in conjunction with surgical oncologists to replace the form and function that can be lost after cancer surgery.
Their work begins long before patients are wheeled into the operating room, Sacks explains. He and his colleagues attend tumor boards and meet regularly with the host of other specialists they frequently work with, including breast surgical oncologists, thoracic surgeons, general surgeons, orthopaedic oncologists and urologists.
“Anyone taking skin, fat, muscle or bone out of the body calls us,” he says.
After formulating a preliminary reconstruction strategy with surgical oncology colleagues to make sure resection and reconstruction can occur seamlessly in conjunction, Sacks and his team then meet with patients in preoperative consultations to relay the plan. Sometimes, operations are textbook—for example, most of the hundreds of breast reconstructions that Sacks performs each year. But depending on the peculiarities of patients’ tumors, Sacks and his colleagues might be performing a procedure unlike any a reconstructive surgeon has done before.
“Sometimes when I go to work, I know exactly how I’ll do a case. But sometimes, I’m not sure how it will work until I get there,” Sacks says. “We need to innovate on the fly, develop new ways to put people back together.” Such innovation has involved using a section of small bowel to replace an esophagus, or moving skin, fat and blood vessels from a patient’s thigh to reconstruct an abdominal wall.
On the day of surgery, Sacks and members of the oncological reconstruction team scrub in and work alongside their surgical oncology colleagues, resecting tumors and reconstructing tissue in the same procedure. Oftentimes, says colon and rectal surgeon Jonathan Efron, Sacks’ skill makes it possible to remove tumors that other surgeons might consider not resectable.
“I create some very large defects in patients’ abdominal wall or in their perineum, and Dr. Sacks always finds a way to close those holes,” Efron says. “He makes it possible for me to take care of people with very complicated cancers. His skill is a key component of the complex cancer surgery performed here.”
In the weeks and months after procedures are completed, Sacks follows up with patients, making sure his reconstructions adequately restored not only patients’ aesthetic appearance but also their functional needs.
“The most rewarding part of my job is when patients walk into my clinic and tell me they thought they were going to lose who they were, and now they feel natural,” Sacks says. “Even though they know they’ve been operated on, they feel whole again.”