"This would be as challenging as the face transplant cases from last year," says Dr. Brendan Stack, chief of head and neck surgery at the University of Arkansas for Medical Sciences. "The main challenges here will be blood loss, blood loss, blood loss, and underlying skeletal deformities."
Dr. David Song, chief of plastic surgery at the University of Chicago Pritzker School of Medicine -- who himself was part of a team that removed a 200-pound neurofibroma from a patient, agrees that there are many characteristics of such tumors that make them particularly difficult to work with.
"Massive bleeding is a major concern," he says. "Blood vessels from within and around a giant neurofibroma can be fibrotic (or hard), dilated and numerous. Any attempt to remove a giant neurofribroma must be taken with great care and planning, including the preparation and anticipation of major blood volume replacement, especially in the face."
But, Song adds, "When performed by the right team with experience, some of this difficulty can be mitigated."
And surgeons at the Fuda Hospital in China appear to be dealing well with the complexities of the surgeries thus far. Chief surgeon at Fuda Hospital Dr. Liu Lizhi told Reuters that Monday's operation, which aimed to remove 10 pounds of the tumor tissue, was not as risky as the larger July operation. But, he said, it was still a challenge.
"Compared to his first operation, the second one has some new issues," he told Reuters. "The main problem is the tumor is close to his ear, and his ear has already been invaded and extended by it ... So we will try to cut the tumor while keeping his ear and reconstruct it after the operation."
But considering the extent of Huang's deformities, surgeons will likely have to address the problem step by step -- and hope for the best.
"The biggest problem in reconstruction occurs when normal structures -- the mouth, ears, eyelids, nose, et cetera -- are stretched out of shape by the weight of a tumor this large," says Dr. Ricky Clay, plastic and reconstructive surgeon at the Mayo Clinic in Rochester, Minn.
"They have to be reshaped and repositioned to match the remainder of the face. There is no set method. It's a combination of anatomy, geometry, and imagination," he says.
"He has massive deformity. The challenge is to remove the tumor and leave normal tissue," says Dr. Brian Maloney, director of The Maloney Center for Facial Plastic Surgery in Atlanta. "He will need multiple surgeries and hopefully not have the huge flaps of tissue but will not look 'normal' ... If the bones of the face are involved he could even lose one of his eyes."
And as with any surgery, scarring will be an issue.
"This type of surgery would require multiple procedures and result in a significant potential scar," notes Dr. Julius Few, associate professor of plastic and reconstructive surgery at the Northwestern University Feinberg School of Medicine in Chicago. "People of Asian and African background have a higher risk for bad scars, such as keloids."
And even after what promises to be an extensive battery of plastic and reconstructive surgery procedures, Huang will likely face continuing difficulties from his condition.
"There will be much tumor left behind," says Dr. Garry Brody, professor emeritus of plastic surgery at the University of Southern California's Keck School of Medicine.