Principles of Genital Aesthetic Surgery in Gynecological Oncology
Özet
Genital aesthetic and reconstructive surgery is increasingly central to survivorship focused gynecologic oncology. Radical operations and adjuvant radiotherapy can produce vulvar, vaginal, and perineal sequelae such as scarring, tissue loss, stenosis, and altered sensation that impair sexual function, continence, body image, and psychosocial well being. This chapter reviews surgical approaches (local and regional vulvar flaps; gracilis or rectus abdominis transfers in irradiated fields; selected split thickness skin grafts; vaginal reconstruction with the McIndoe technique, bowel segment interposition, or minimally invasive peritoneal vaginoplasty); psychosexual outcomes assessed with validated patient reported tools including the Female Sexual Function Index, Body Image Scale, and Hospital Anxiety and Depression Scale, alongside expectation management, pelvic floor rehabilitation, and psychosexual therapy; ethical, legal, and cultural frameworks grounded in autonomy, beneficence, nonmaleficence, and justice, with enhanced informed consent, precise classification of reconstructive versus elective procedures, institutional oversight, and culturally competent, trauma informed counseling; and timing with multidisciplinary planning that balances immediate and delayed reconstruction while preserving oncologic control. Future priorities include protocolized minimally invasive peritoneal techniques, regenerative volume restoration, routine integration of patient reported outcomes, and training and equity initiatives. Genital aesthetic reconstruction should be regarded as core survivorship care that restores dignity, function, and quality of life.
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