Reconstruction, Reinvention, Redirection

21/12/2015 12:55 GMT | Updated 20/12/2016 10:12 GMT

What does it mean to be whole? As a reconstructive surgeon I'm faced with that question every day as I help people who have to deal with the after effects of cancer disease, road traffic accidents or massive trauma.

We are visual creatures and social animals; there is little doubt that physical appearance exerts both subtle and profound effects on human relations. If the way you look changes, the way you see yourself changes, as can the way others' perceive you.

Reconstructive and plastic surgery in the UK developed in response to the grotesque injuries of the "great" World wars and the consequent medical ingenuity required to keep tissues alive whilst moving them from place to place.

The psychological and social toll of suffering from such injuries is considerable. We talk about "life-changing injuries" and modern surgery and medicine can do much to preserve life and hope where it once seemed impossible. Even now we are developing new techniques to rebuild wounded warriors.

Over the next few months a team at Johns Hopkins University School of Medicine in Baltimore expects to start penis transplants in soldiers who suffered genitourinary injuries as a result of bomb blasts in the current wars in Iraq and Afghanistan.

The after-effects of such "life-changing" injury or disease can tear through someone's sense of self. My respect for reconstruction derives from recognition that it is so much more than simply correcting a deformity or resurfacing a wound; it has an inherent ability to reconstruct a whole person, relationships, the future.

As plastic surgeons we recognise the profound psychological dimension to our work as we suture back hope, wholeness, wellbeing. As much as we work to restore physical form and function, we are also repairing self-image.

Of course one person's traumatic deep psychological wound, may be another person's trivia. The crux of the matter is what it means to you, your personal definition of what it means to be whole.

Breast reconstruction is an easily understandable example of the psychological significance of loss. Breasts have become a socially overt currency of female sexuality and their loss may be felt both personally and publicly.

A mastectomy is not strictly about losing femininity - most women are resilient enough to withstand that- rather the loss of a breast may be an abrupt, unexpected interruption to wellbeing. You are no longer intact - disease has taken an obvious part from you.

Reconstructive surgery is ostensibly undertaken to return shape and symmetry, but the primary goal is in fact to facilitate positive psychological change. Plastic surgery acting as a singular salve to both physical and psychological wounds.

As a breast reconstruction specialist, I am acutely aware of how our mastery of breast reconstructive surgery has extended the role of surgical intervention to healthier and younger lives.

Now, risk reducing surgery is recommended for those with a genetic predisposition to breast cancer. The risks are indisputable - an 80-85 per cent lifetime risk of cancer warrants consideration of the removal of both breasts. The results of reconstruction are life affirming and very welcome. There are however unintended consequences: the social perception of the enormity of the diagnosis has changed; because the visual outcomes are entirely acceptable even desirable.

Being a doctor is an immense privilege; you are invited into the most extreme moments of people's lives. Combined with curiosity and compassion, it allows an insight into the human condition, Medicine as magnifying glass.

Surgery undoubtedly wields a sharp scalpel, it cuts swiftly and precisely. It need never be the answer to any question, but when required, it can be used as a force for good, to carve out a new life.