Sumeet S. Teotia, M.D. Answers Questions On: Breast Reconstruction
The word “flap” is used a lot in breast reconstruction. What does that refer to?
There are a lot of “flap” procedures in breast reconstruction, such as DIEP, SIEA, double-stacked flaps, TRAM, TUG, PAP, and SGAP/IGAP. With these procedures, we use tissue from other parts of the body to reconstruct the breast using a microscope to link the small arteries and veins in the chest, so there are generally no implants involved.
In the DIEP (deep inferior epigastric artery perforator) or SIEA (superficial inferior epigastric artery perforator) procedure, we use tissue from the abdomen to build the new breast. With the TUG (transverse upper gracilis) or PAP (Profunda artery perforator), we use tissue from the inner thigh area.
And with the SGAP (superior gluteal artery perforator), we take tissue from the upper buttocks area. Basically, “flap” means any tissue with a blood supply, or that is generally connected to a main artery and vein, which are linked to blood vessels in the chest (IMA/IMV). In the double flap or stacked flap procedure, various unique combinations of DIEP/SIEA or other flaps are used to reconstruct a breast, generally one sided.
Are patients concerned about having something “missing” from another part of their body?
The patient isn’t usually concerned with how the tissue got there to make a beautiful breast. What they do care about is whether the breast will appear symmetric, and if it’s attractive and natural looking. When they’re pleased, it helps build their confidence and self image.
Are there any advances in cosmetic and reconstructive surgery that patients can look forward to?
Breast reconstruction patients can look forward to a wide array of choices for their reconstruction, with one patient never fitting exactly like another one. Hence the result is unique and tailored to their desires and their anatomy, something that would be natural to them with less long-term morbidity, despite the invasiveness of a procedure.
Patients can also look forward to various evolving options in implant-based reconstruction that are safe, reliable, and long-term, and that also minimize potential morbidity that can result from autologous reconstruction.
As nipple-sparing mastectomies and double mastectomies become more popular, and as patients have wider options with fully informed decisions about what is best for them, we can generally accommodate their wishes.
In fat grafting, which is an adjunctive part of my practice, patients should expect less down time, increased success, and more natural results. In the future, there will also be less-aggressive surgery in order to achieve results that used to be achieved with more aggressive procedures.
However, we shouldn’t give up the classical, tried-and-true methods for breast reconstruction and other cosmetic procedures that have been done for decades. They still work beautifully, are safe, and they still stand the test of time with long-term success. Those procedures form the foundation and roots of our current techniques. New doesn’t always mean better or safer.
More patients are informed, and it helps me to tailor their cosmetic and reconstructive outcomes to their desires as best as I can.
You’re also a medical illustrator. How does that help you in your surgical practice?
I’ve been an artist for most of my life, and I teach drawing courses to UT Southwestern medical students in small group sessions.
I believe art, and in my case, classical art and drawing, gives you a keener sense of observation and helps people understand perspective, light, and shadows in an analytical and scientific manner. It also allows you to see natural beauty in different terms.
Concentrating on developing my own artistic skills away from being a surgeon makes me a better plastic surgeon, in my opinion. It also makes me a better teacher and a better mentor for my residents and students who are interested in the visual world. If I can teach them how to see things differently, and the way we observe the world, then perhaps, in my opinion, they can become better-thinking physicians and surgeons, and perhaps better plastic surgeons.