Reconstructive Plastic Surgery

The PAP flap rebuilds the breast using skin and fat from the upper thigh, an option for patients who cannot use abdominal tissue. Dr. Brian Kelley, an Austin microsurgeon, explains who the thigh suits, how much volume it provides, where the scar sits, how outcomes and patient-reported satisfaction compare with DIEP, and the donor-site trade-offs worth understanding before choosing. Covers candidacy, stacked flap options for more volume, radiation, risks, and recovery.

The SIEA flap rebuilds the breast from lower abdominal tissue without cutting any abdominal muscle or fascia, the least invasive abdominal option. Dr. Brian Kelley, an Austin microsurgeon, explains what the SIEA flap is, how it compares to the DIEP and to thigh-based PAP flaps, why it is only feasible in a minority of patients, what delay procedures can and cannot do, and who is a candidate. Includes monitoring, recovery, and honest limitations.

BRCA1, BRCA2, and other high-risk genes change how breast reconstruction is planned. Dr. Brian Kelley, an Austin reconstructive surgeon, explains how reconstruction differs for genetic-risk patients, the choice between prophylactic and therapeutic mastectomy, nipple-sparing options and the small residual risk in the preserved nipple, implant versus autologous reconstruction, coordination with other risk-reducing surgery, and lifelong monitoring. Written for patients carrying a hereditary cancer mutation who are weighing risk-reducing surgery and reconstruction.