Flap-Based Breast Reconstruction in Houston, TX

Breast reconstruction with an autologous tissue flap is an extremely personalized procedure at Chevray Plastic Surgery in Houston, TX. Our board-certified plastic and reconstructive surgeon, Dr. Pierre Chevray, offers in-depth consultations to patients seeking his expertise in performing breast reconstruction.

If you are considering breast reconstruction surgery, it is important that you have realistic expectations. While Dr. Chevray strives to create a natural appearance, your newly reconstructed breast(s) will not have the same feeling or identical look as your original breast(s). There are several options in flap-based breast reconstruction (DIEP, SIEA, TRAM, GAP, or PAP). Each flap is named for the area where the donor tissue is harvested from, be it the abdomen, thighs, or buttocks. Flap-based breast reconstructions require staged surgeries that may be performed along with your breast cancer treatment or delayed until a later date. Dr. Chevray can create a unique treatment plan with a compassionate approach to restore your confidence and physical appearance at Chevray Plastic Surgery. Call for a consultation to start the journey. We will be with you every step of the way.

You may be considering a flap-based breast reconstruction if you:

• Just received a breast cancer diagnosis
• Are considering or planning a prophylactic mastectomy after testing positive for a BRCA1 or BRCA2 gene mutation
• Are deciding to have an immediate or delayed breast reconstruction and want to know your options

You may not be a candidate for certain flap-based breast reconstruction if you:

• Have heart failure, or COPD
• Are a smoker (or quit for at least two weeks before surgery)
• Have had a tummy tuck on your belly

If you have had chemotherapy or radiation, it will not disqualify you from the DIEP, SIEA, or TRAM flap reconstructions. Dr. Chevray will wait six months after your last radiation treatments before starting your series of reconstructive surgeries. He also waits one month after any chemotherapy treatment so that your white blood cell count and your immune system can recover from the chemotherapy.

The most common flap-based breast reconstructions that Dr. Chevray performs come from the bottom portion of the abdomen. The deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, and the transverse rectus abdominis myocutaneous (TRAM) flap all improve the contour of the abdomen following surgery. Once the incisions are made, the belly fat and skin are removed, and the belly skin will be closed tight. Each surgery has its own benefits and risks, such as:

• DIEP
  The DIEP flap is one of the most popular flap surgeries because it is muscle-sparing and does not substantially weaken the muscles needed for core strength. The small artery and vein of the DIEP flap come up through the rectus abdominis muscle, which is why this belly muscle needs to be incised. These blood vessels are then reattached to small blood vessels in the chest, behind the ribs, using microsurgery. Incisions may be made to the muscle and fascia in the abdomen to access blood vessels, but muscle or fascia will not be removed.
• SIEA
  In the SIEA flap reconstruction, you will have a shorter operation compared to the DIEP and TRAM procedures because there are no muscles or fascia to cut or remove. The small artery and vein used in this flap run along the abdomen just below the skin's surface and are easier to access. The SIEA flap for breast reconstruction also requires microsurgery and is therefore a microsurgical flap.
• free TRAM
  The free TRAM flap involves the removal of some of one of the rectus abdominis muscles and some fascia in the lower abdomen. This is why Dr. Chevray rarely uses the free TRAM flap. Just like the DIEP or SIEA flaps, this is a microsurgical flap, and Dr. Chevray will make a long horizontal incision (hip bone to hip bone) and an incision around the navel to harvest the flap of skin and fat to reconstruct the breast. The same small blood vessels as in the DIEP flap have to be microsurgically attached to a small artery and vein at the chest. Recovery time for the free TRAM flap is somewhat longer than the DIEP and SIEA flaps because some of the belly muscle is removed with the flap. With any type of TRAM flap, women risk the development of an abdominal bulge and noticeable muscle weakness.
• pedicled TRAM
  The pedicled TRAM flap involves the removal of all of one of the rectus abdominis muscles and some fascia in the lower abdomen. This is why Dr. Chevray almost never uses the pedicled TRAM flap. The pedicled TRAM flap does not involve microsurgery. However, like the DIEP, SIEA, or free TRAM flaps, Dr. Chevray will make a long horizontal incision (hip bone to hip bone) and an incision around the navel to harvest the flap of skin and fat to reconstruct the breast. When a pedicled TRAM flap is performed, blood vessels do not have to be reattached with microsurgery. However, the recovery time is increased compared to the DIEP and SIEA flap surgeries because all of the rectus abdominis muscle is moved. With the pedicled TRAM flap, women risk the development of an abdominal bulge and will have some belly muscle weakness.

The profunda artery perforator (PAP) flap may be recommended if it is not possible to harvest enough tissue from the abdomen. As a muscle-sparing flap, the PAP only takes the skin, fat, and small blood vessels from the inner and posterior thigh. The benefit of having a PAP flap is that the incision scar can be concealed in the crease of the inner thigh and buttock, resulting in a thigh lift. Dr. Chevray will contour the thigh to have a shapely appearance.

Women who do not qualify for donor tissue to be removed from the abdomen or thighs may have sufficient tissues to harvest from the buttocks. This is called a GAP (gluteal artery perforator) flap, and it is a muscle-sparing procedure. There are two variations of the GAP flap. The SGAP (superior gluteal artery perforator) flap can be used with donor tissues from the upper buttocks. The IGAP (inferior gluteal artery perforator) flap can recreate the breast with donor tissues from the lower buttocks, and it produces a concealable scar within the crease of the buttocks. Small blood vessels are reconnected at the chest and breast with microsurgery so that the flap has optimized blood flow.

Flap-based breast reconstructions require an inpatient stay for several days. If you have unilateral or bilateral breast reconstruction with a flap, you will typically be in the hospital for 3 – 4 days. Depending on the surgery and the patient, the recovery time can be longer. On the day you leave the hospital, you will be able to shower, walk, eat a regular diet, and will have antibiotics and pain medication prescribed by Dr. Chevray. You will most likely have drainage tubes. You will return for follow-up visits with Dr. Chevray to check your progress and remove the drains, usually about a week after you leave the hospital. Dr. Chevray will not want you to perform strenuous activities or exercise for about five weeks after your surgery date. Dr. Chevray will release you to go back to work, to drive, and to exercise at the gym. We want you to have patience with your body, give yourself a lot of TLC, and time to heal. At any time you need to ask a question or have a concern, you can call our office for assistance.

How do I choose the right flap-based breast reconstruction?
Making the decision to have flap-based breast reconstruction is a huge decision, no matter who you are. Dr. Chevray understands that you may feel overwhelmed with all these options and what they will mean for you. He has spent many years honing his expertise in breast reconstruction, and Dr. Chevray is very approachable and caring. He will answer your questions and talk you through any concerns. We hope that this puts your mind at ease. You do not have to make these decisions alone. Even if you decide to not have breast reconstructive surgery, you can count on us to support your decisions about your health.

Will you recreate my nipple/areola complex?
There are a few ways we can go about restoring your nipple/areola complex. As a second surgery, nipple reconstruction will take place three or more months after your original breast reconstruction surgery. Dr. Chevray will use this surgery as an opportunity to optimize the overall appearance, size, shape, position, and symmetry of your breasts in what is an outpatient revision and symmetry surgery. Alternatively, the nipple may be reconstructed as a separate in-office procedure that takes about an hour of your time. A third option is to have a 3-D nipple-areolar tattoo where a tattoo artist draws a nipple and areola. This 3-D tattoo can look very realistic.

How long is flap-based breast reconstruction?
Microsurgical flap breast reconstruction typically takes 5 – 6 hours of surgery, and 3 – 4 nights in the hospital. Keep in mind that flap-based breast reconstruction, like any method of breast reconstruction, usually involves two separate surgeries, separated by at least three months. In microsurgical flap breast reconstruction, you will have donor skin, fat, and small blood vessels removed from one area of your body and essentially transplanted to your chest to reconstruct a breast.

Dr. Chevray is sensitive to the needs of all his patients who have had their breasts removed out of medical necessity. With his extensive training, he is able to perform complex microsurgical flap-based breast reconstructions with great success rates. He will recreate your breasts to feel warm and soft like your natural breasts using your own living tissues. If you are interested in our innovative techniques available to you at Chevray Plastic Surgery, we invite you to schedule a consultation at our Houston, TX or Sugar Land, TX practice.