BRCA1 Prophylactic Mastectomy Recon with DIEP/SIEA Flaps in The Woodlands, TX

Procedure Details

This is a delightful woman with a family history of breast and ovarian cancers. She tested positive for a mutation in the BRCA1 gene, which greatly increases her lifetime risk of developing breast cancer. The patient decided to have risk reduction surgery with bilateral skin-sparing prophylactic mastectomies. Notably, she had prior cosmetic breast augmentation with saline implants. However, she preferred tissue-based reconstruction using her lower abdominal tissue to avoid future surgeries for implant maintenance. She also desired more natural feeling reconstructed breasts. In the same surgery as her mastectomy, she had immediate breast reconstruction with an SIEA flap on the right and DIEP flap on the left (the type of flap used was determined by the vascular anatomy encountered in surgery). In addition, her DIEP and SIEA flaps were innervated with a cutaneous sensory nerve using a nerve graft; the ReSensation technique was used. The patient had 1 revision procedure 3 months later for fat grafting and scar revision to optimize her final outcome. She chose to have nipple areola tattooing without formal nipple mound reconstruction.

Restoring Breast Sensation

The lower abdominal tissue flaps used to reconstruct the breasts, an SIEA flap and a DIEP flap in this case, were innervated (or neurotized).  This additional procedure is performed to increase the likelihood of restoring natural sensation to the reconstructed breasts.  While isolating the blood vessels that supply the flap, sensory nerves are also identified and tagged.  Once the tissue is moved to the breast pocket, the sensory nerves are connected to intercostal nerves that were cut during the mastectomy.  Sometimes the connection is a direct one between the flap nerve and the intercostal nerve.  Sometimes a nerve graft is used to provide length and bridge a gap.


Houston Methodist Hospital

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.