Cancer and Trauma Patients Undergo Plastic Surgery

How plastic surgeons help cancer and trauma patients through reconstruction.
Dr. Jess Prischmann of Prischmann Facial Plastic Surgery, is Minnesota's first female facial plastic surgeon.

Edina is home to Minnesota’s first female facial plastic surgeon. Dr. Jess Prischmann opened Prischmann Facial Plastic Surgery in April of this year. Minnesota is home to other female plastic surgeons, but Dr. Prischmann’s specialty is different. She’s a board-certified otolaryngologist, a head and neck surgeon who is also a facial plastic and reconstructive surgeon. Prischmann was the second woman ever accepted for fellowship in facial plastic and reconstructive surgery with Dr. Stephen W. Perkins, a leader in the field.

Prischmann’s office is welcoming and relaxing, reflecting her desire to connect with patients and help them feel comfortable. Many minor procedures can be done right in her office, but surgeries requiring heavier sedation are performed at Fairview Southdale Hospital or Centennial Lakes Surgery Center.

Contrary to the perception that all cosmetic surgery is done to combat aging or enhance beauty, many of the surgeries that Prischmann performs are for reconstructive purposes. She says there are typically two needs for reconstructive surgery: reconstruction after cancer or after trauma such as a dog bite or a fall.

Mohs micrographic surgery is commonly performed by dermatologists to remove many types of skin cancers. If the surgical area is small, it might heal on its own or be repaired by the dermatologist; this is rare. But if the surgical area is extensive, complex or in a cosmetically sensitive location like lips, nose, ears or eyelids, patients are often referred to specialists like Prischmann.

“The primary goal is to restore and maintain function,” says Prischmann. “Cosmetic concerns are secondary.” She goes on to detail how simply closing a large surgical area on a patient’s cheek could result in a drooping eye or a lifted corner of the lip; Prischmann’s job is to prevent such occurrences. Her specialized skills mean she can elevate and rotate portions of skin to help patients regain a natural appearance and avoid other potential problems like dry eye.

Skin cancer, the most common of all cancers, can be serious. Prischmann had a patient who lost part of her lip, cheek and nose as a result of cancer surgery. After three stages of procedures and the use of tissue from the patient’s cheek and forehead, Prischmann reconstructed her patient’s face. “This is part of what I love about my work,” she says. “Being able to restore something to my patients that they believe is forever lost, looking like themselves again.”

She loves a challenge. She describes a trauma patient from the Netherlands who tumbled over her bicycle handlebars and lost her nose from the skidding fall. Initial surgeries were unsuccessful in fully repairing the damage, so the patient was referred to Dr. Stephen Perkins, Prischmann’s mentor. Together, Perkins and Prischmann were able to give the patient a natural-looking nose.

“Every patient is different,” says Prischmann. “There is no pat answer on how to solve every problem. At first I’d review potential procedure options 20 to 30 times before deciding on how best to achieve a great result. Now I also run photographs by other experts and am always learning from others’ best practices.” She goes on to add with animated awe that one particular textbook procedure detailing how best to reconstruct a nose has been found in Indian techniques from as far back as 700 B.C.

Dr. Jacqueline Luong of Midwest Plastic Surgery is equally passionate about helping patients recover what’s been lost. Dr. Luong received her training in plastic surgery at the Mayo Clinic in Rochester, where she was on the staff for several years. She joined Midwest Plastic Surgery in Edina in 2005, where she specializes in breast and cosmetic surgery.

According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer for women (excluding skin cancer), and cancer researchers with the University of Minnesota’s Masonic Cancer Center and Medical School have found that women younger than 40 are most likely to opt for double mastectomy surgery after cancer diagnosis. These younger women are also most likely to choose breast reconstruction, whereby surgeons like Luong rebuild the breast with techniques using implants or repositioning the woman’s own tissue.

Luong says, “Women are often referred to us by cancer centers like Fairview Southdale Cancer Clinic, Fairview Ridges Cancer Center or Virginia Piper Cancer Institute to explore reconstruction options. Women who aren’t referred to a plastic surgeon need to ask for a referral if they’re interested in reconstruction. Patients may be unaware that federal law requires insurance coverage for reconstructions after mastectomy.”

Why a woman might choose more surgery instead of prosthesis? Luong says that breast reconstruction often does involve more than one surgery and many months to complete. But some women prefer this route because prostheses often don’t fit well, and breast reconstruction makes getting dressed easier. “Prostheses can slide around and be very bothersome for active women,” Luong says. “I once had a patient who lost her prosthesis while swimming at a beach on vacation. No one wants that to happen. They especially don’t want the embarrassment of asking around to see if anyone has found it.”

Another subset of plastic surgery is called microsurgery. Similar in theory to organ transplant, a microscope is used to reconnect blood vessels and nerves of vessels and tissue, and reconstruct areas affected by cancer or trauma. Dr. David Ruebeck of Midwest Plastic Trans-planted Surgery says this technique is common in breast reconstruction but can also be used to reconstruct other areas damaged by cancer. “For instance,” says Ruebeck, “people may not know that thigh or leg tissue can be used to create a tongue and help a mouth cancer patient regain the ability to swallow. Plastic surgeons can also utilize microsurgery to repair tendon lacerations, severed fingers, hands and arms. Complex wounds resulting from extensive cancer radiation can also be fixed through tissue transplant microsurgery.”

While not all plastic surgeons perform all types of complex microsurgery, Ruebeck has completed a fellowship in microsurgery/hand surgery at RK Davies Medical Center in San Francisco, making him one of the country’s top microsurgeons. He says one of the reasons he’s drawn to this specialty is that few surgeries are ever the same. From cleft lips to skin grafts, plastic surgeons are able to help all types of people, from babies to the elderly.

Edina is not only home to Minnesota’s first female facial plastic surgeon, but the local medical community offers an array of extremely talented plastic surgeons whose goals reach well beyond the reality-TV concept of cosmetic surgery.