Breast Reconstruction After Cancer

Rafi Bidros, MD, FACS Plastic and Reconstructive Surgeon Memorial Hermann Katy Hospital

Rafi Bidros, MD, FACS
Plastic and Reconstructive Surgeon Memorial Hermann Katy Hospital

While facing breast cancer, many women struggle to deal with the cosmetic side effects of treatment. Thanks to advances in microsurgery over the last decade, new reconstructive procedures are available to women following mastectomy, including the deep inferior epigastric perforator (DIEP) flap, which is performed by only about 10 percent of plastic and reconstructive surgeons in Houston.

“Microsurgical procedures can provide women with a very natural-looking breast reconstruction using abdominal tissue,” said Rafi Bidros, MD, FACS, a plastic and reconstructive surgeon affiliated with Memorial Hermann Katy Hospital. “Because they do not use abdominal muscle, they tend to result in fewer donor site complications. But microsurgical reconstruction is more complex, with a higher risk of complication, and should be performed only by plastic surgeons who perform microsurgery regularly in institutions with experience in monitoring the flaps postoperatively.”

“My goal is to perform autologous reconstruction so that women who have their own natural breast on one side can obtain natural tissue for the other breast, which helps achieve better symmetry,” he said. “Because skin and fat are removed from the belly, having a DIEP flap means your belly will be flatter and tighter as with a tummy tuck. In most cases the scar is below the bikini line.”

Prior to the DIEP flap, the pedicled transverse rectus abdominis myocutaneous (TRAM) flap had been the most common method of tissue reconstruction after mastectomy.

With a TRAM flap, abdominal muscles, tissue, skin and fat are used to create a natural breast shape. Unlike the TRAM flap, the DIEP flap does not remove muscle tissue unnecessarily, which Bidros believes results in a faster recovery. Additionally, no mesh material is required to support the abdominal wall in a DIEP flap. “It’s a bigger surgery, but it will last a lifetime, unlike an implant, which usually requires more maintenance,” explained Bidros.

Bidros continued his training in DIEP flap breast reconstruction with several renowned DIEP specialists, including Belgian surgeon Phillip N. Blondeel, MD, PhD, FCCP, an internationally known expert on aesthetic and reconstructive breast surgery and a pioneer of perforator flap surgery.

Bidros offers his patients the full range of options for reconstruction, including shaped implants, DIEP and other perforator flaps, fat grafting and hybrid techniques, as well as partial breast reconstruction for lumpectomy patients. “I’m not biased toward one surgery or the other,” he said. “I meet with patients and review the pros and cons to find the best match for each woman. The most important thing is to do it right the first time,” said Bidros. “I believe that women have the right to feel whole again after breast cancer.”

Bidros also encourages prospective breast reconstruction patients to preplan with the breast surgeon for a better outcome. “With a team approach, the success rate is very high,” he said. “Ultimately, the final choice of flap depends on the patient’s anatomy and the quality of the tissue harvested. Different surgeons produce different results. The refinements we offer in breast surgery are based on aesthetics. Part of that is the innate ability of the surgeon, and part of it comes with experience.”