Why Cancer Removal and Reconstruction Are Usually Two Surgeons

This is a fantastic question: if you're a patient with cancer, why do you have to have two different surgeons treat you? Why does one surgeon remove the cancer and a different surgeon reconstruct you?

There are three real reasons, and then there's a personal one.

The first reason is training.

I happen to be a general surgeon as well, so I have full general surgery training on top of plastic surgery. But not all plastic surgeons do. If you do a combined or integrated program, you only complete a few years of general surgery, and you would not be eligible for your general surgery boards.

That has practical consequences: some hospitals would not allow you to do certain types of tumor removal without that background. (This is one of the many places where hospital privileges quietly shape who is allowed to do what.)

This is the reason I find most compelling, and it's the one patients rarely hear.

• When you remove the cancer, you want everything gone. You do not want to leave anything behind.
• When you do the reconstruction, things look better if there's more left behind.

Those are, quite literally, opposing objectives inside the same operation.

That's not an accusation against surgeons who do both. It's an honest acknowledgment of how human judgment works when you're the person holding both goals at once.

Oncology and surgical oncology on one side, reconstructive surgery on the other. These are two massive fields of medicine, both constantly evolving.

It would be very, very difficult to stay genuinely on top of everything happening in both. Most of us would rather be excellent in one lane than adequate in two.

I want to be fair here: it's not unethical to do both, and there are surgeons who do. What you'll notice is that they tend to stick to one specific area.

Where you do see it:

• Plastic surgeons who are also general surgeons doing breast cancer treatment and reconstruction
• Surgeons doing skin cancer treatment and reconstruction

Where you essentially never see it:

• Colon cancer treatment and perineal reconstruction. That's almost always two different surgeons.

And one I'll be blunt about: I've known a handful of thoracic surgeons who do their own latissimus flaps. I'm not a big fan of that, but it does happen.

Beyond the three reasons above, I have a personal one, and it's honestly my favorite part of this job.

I love my role as the plastic surgeon, because I'm the one giving the patient something back.

I also like my role as a communicator, a kind of health translator. Your relationship with your plastic surgeon tends to be much longer term, and you see them more frequently, than the other doctors involved in your cancer treatment. I genuinely like that role.

So even though I'm qualified to venture into other areas, I'd rather stay right here.

Cancer removal and reconstruction are usually two different surgeons because of training (not every plastic surgeon can do the cancer operation), because the goals of the two operations conflict (take everything out versus leave more behind), and because both fields are too big to stay expert in simultaneously.

It isn't unethical for one surgeon to do both, and in breast and skin cancer you'll see it done well by surgeons with both trainings. But two surgeons, each focused on their own job, is the norm for good reasons.

And whoever does your reconstruction should care about the result you live with afterward, which is a hill I'll die on. If you're preparing for a mastectomy, here's how to evaluate the surgeon doing the cancer operation.