If You Don't Care How Reconstruction Looks, Put the Scalpel Down

A couple of days ago I posted about why I'm personally not a big fan of the same surgeon doing both the cancer removal and the reconstruction in most situations. Someone in the comments reminded me of another reason, one I hadn't even mentioned in that video.

Their argument was this: with certain types of cancers, aesthetics are not a concern. It's only function. And, bizarrely, they were claiming this about head and neck cancers.

I find that so horribly offensive, and I'm flabbergasted that any surgeon thinks that way.

Let me say the obvious part out loud, because apparently it needs saying: part of reconstruction is function, but it's also aesthetics. Those aren't competing goals. They're both the job.

Sometimes we're not able to hit it out of the park. We can't always get someone looking exactly the way they did before, whatever the situation was: cancer, trauma, something else. That's real, and honest surgeons say so.

But we should always try.

Here's the timeline that I think makes this indefensible.

When a patient comes to us after trauma or a cancer excision, they are, God willing, done with their treatment or the aftermath of their trauma within six to twelve months of when we meet them.

But they are living with our reconstruction for literally decades, hopefully.

And in the specific case being argued about here? It's their face.

This is the question I'd put to any surgeon who believes aesthetics don't matter in reconstruction: what if it were you?

What if it were your face that someone decided only needed to work, not to look like anything in particular? What if the person holding the scalpel decided in advance that how you'd look for the next thirty years was not their problem?

I don't say that lightly. Operating on another human being is a privilege, not a right, and part of the deal is caring about what they have to live with afterward.

This is exactly why I've said I'm generally not a fan of one surgeon doing both the cancer removal and the reconstruction. A comment like this one is a perfect illustration of the mindset problem: if a surgeon genuinely believes appearance is irrelevant to a cancer patient's outcome, that belief is going to show up in the result the patient lives with.

You want someone doing your reconstruction whose entire focus is the reconstruction, and who considers how you'll look to be a real part of their job. It's the same instinct behind demanding a real reason if you're told you can't have immediate reconstruction, and behind finding a new surgeon when you don't trust the one you have.

Reconstruction after cancer or trauma is both function and aesthetics, and that's as true for the face as it is for the breast. We won't always achieve a perfect result, but trying our hardest is the baseline, not an extra.

Patients finish treatment in six to twelve months. They live with our work for decades. If a surgeon can't bring themselves to care how that work looks, they shouldn't be doing it.

You should always care. Patients deserve to be treated like people at every step, and that includes the part they see in the mirror for the rest of their lives.