The Blog

Breast reconstruction is protected by federal law, but real coverage gaps remain. Dr. Brian Kelley, an Austin reconstructive microsurgeon, walks through WHCRA, Texas Medicaid (MBCC), Travis County MAP, and the Seton charity care he participates in for patients without standard coverage. The post also covers the Breast Cancer Resource Center, the coverage gray zone for sensate reconstruction and prophylactic lymphedema surgery, and how to appeal when these procedures are denied.

The DIEP flap is the most common autologous breast reconstruction, but not every patient is a candidate — some are too thin, have had prior abdominal surgery, or prefer a different donor site. Dr. Brian Kelley, a microsurgeon in Austin, walks through the alternatives: PAP, TUG, SGAP and other free flaps; the latissimus dorsi flap; and his work offering autologous reconstruction to charity-care and Travis County MAPs patients who otherwise wouldn't have access.

Patients who have had peripheral nerve surgery generally do well, but when surgery doesn't deliver the expected result and significant pain or loss of function persists, the experience is uniquely difficult. Dr. Brian Kelley, a fellowship-trained hand and peripheral nerve surgeon in Austin, explains when a second opinion is reasonable, why specialist experience matters for complex nerve revision, what the evaluation actually involves, and what options exist — including when more surgery is and isn't the answer.

If radiation is part of your breast cancer treatment, the reconstruction decision becomes a question of durability. The published evidence consistently favors autologous (your own tissue) reconstruction over implants in radiated tissue — both in complication rates and in long-term patient-reported satisfaction. Dr. Brian Kelley, a microsurgeon in Austin and co-author of several studies on radiation and breast reconstruction, explains the evidence, the options, and how to choose a durable result for the long term.

Many patients who had a breast reconstruction in the past are unhappy with the result or developed a complication and assume they are stuck with it. Usually they are not. Dr. Brian Kelley, a reconstructive microsurgeon in Austin, explains the realistic options for revising a prior reconstruction — cosmetic refinement, converting implants to your own tissue, improving or salvaging a prior flap with other donor sites, or converting to aesthetic flat closure — and what the outcomes data show.

Sex and intimacy after breast reconstruction is one of the most important parts of recovery and the least honestly discussed. Up to 85% of breast cancer patients report sexual health concerns, yet few receive guidance. Dr. Brian Kelley explains what actually changes — sensation loss, body image, the effects of cancer treatment — what surgery can and cannot restore, what the patient-reported outcomes data show, and where to find real help. An honest, evidence-based conversation.

For many amputees, the hardest part of life after amputation is the pain. Targeted muscle reinnervation (TMR) is a surgery that reroutes cut nerves to nearby muscles, giving them a target and preventing the painful neuromas behind phantom limb and residual limb pain. Dr. Brian Kelley, trained in nerve surgery at the University of Michigan, explains how TMR works, what recovery involves, and what the patient-reported outcomes data show — including durable pain relief and reduced opioid use.

WALANT — wide awake local anesthesia no tourniquet — lets common hand procedures like carpal tunnel and trigger finger release be done with the patient fully awake, without sedation, general anesthesia, or a tourniquet. Dr. Brian Kelley explains how the lidocaine-and-epinephrine technique works, why injecting epinephrine into the hand is safe, and how it compares on recovery, cost, and patient-reported outcomes. Randomized data show less postoperative pain, lower analgesic use, and higher satisfaction than conventional anesthesia.

Not every patient who has a mastectomy wants reconstruction, and choosing to go flat is a valid, increasingly common decision. Aesthetic flat closure is doing that choice well — intentionally contouring the chest for a smooth, flat result. Dr. Brian Kelley explains the techniques, recovery, and outcomes, why most patients don't need a plastic surgeon for it, and the role a plastic surgeon plays in refinement, in converting a reconstruction to flat, and in delayed reconstruction later.

Choosing between implant-based and autologous breast reconstruction comes down to a few key questions: whether you need radiation, whether you have adequate donor tissue, and how you weigh a shorter recovery against a more durable result. Dr. Brian Kelley lays out a six-question framework and reviews the patient-reported outcomes data — including large multicenter studies showing autologous reconstruction tends to produce higher long-term satisfaction — alongside the recovery timelines, risks, and complication rates for each pathway.

Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) both give a divided nerve a new target after amputation, preventing painful neuromas and enabling prosthetic control. TMR reroutes the nerve into an existing muscle; RPNI wraps it in a small free muscle graft. Dr. Brian Kelley, trained at the University of Michigan where RPNI was pioneered, explains how the two differ, when each is used, and what the published outcomes show.

Most patients do well after carpal tunnel or cubital tunnel release, but a meaningful minority have symptoms that persist, recur, or never fully resolve — and the experience is discouraging. Dr. Brian Kelley, a hand and peripheral nerve surgeon in Austin, explains why decompression sometimes doesn't produce complete relief, what the published outcomes data actually show, the role of repeat EMG before revision, and what options exist — including when nerve reconstruction is needed.

Hybrid breast reconstruction combines an autologous flap, typically DIEP, with a breast implant placed behind the flap. The technique is offered to patients who want flap-based reconstruction but have limited donor tissue, who want a larger reconstruction than the flap alone could provide, or who have a thin chest wall after radiation. The implant sits in a healthier biological environment than in standard implant reconstruction, with a long-term risk profile closer to cosmetic augmentation.

Dr Brian Kelley outlines the realistic, staged recovery timeline for DIEP flap breast reconstruction. It details expectations from the initial hospital stay and flap monitoring through early home recovery, highlighting drain care, activity restrictions, and potential warning signs. The text explains the gradual return to function, work, exercise, and intimacy over subsequent months. Emphasizing that recovery involves physical, psychological, and social dimensions, the guide addresses long-term considerations, physical therapy, and the timing of refinement procedures to assist patients in preparing for a multidimensional, year-long healing process.

Autologous fat grafting uses the patient's own fat — harvested through low-pressure liposuction, processed, and injected in small aliquots — to refine reconstructive results. The technique is most useful in breast reconstruction for softening implant contour irregularities and post-radiation tissue, in Mohs and oncologic reconstruction for residual contour deficits, and in trauma and burn reconstruction for scar release and volume restoration. Outcomes are favorable in selected patients but require staged sessions because not all injected fat survives. Dr. Brian Kelley, board-certified plastic surgeon in Austin, explains the established reconstructive uses, realistic outcomes, and risks.

Being told your nerve test is normal when the pain is unmistakably real is frustrating — and the assumption behind it is wrong. A normal EMG does not rule out nerve compression. Dr. Brian Kelley, a hand and peripheral nerve surgeon in Austin, explains why these tests miss many real cases — from carpal and cubital tunnel to small-fiber neuropathy and other compression syndromes — how the diagnosis is actually made, and when treatment is appropriate despite normal testing.

Classic operations like TRAM flap helped bring about autologous breast reconstruction, but modern techniques like the DIEP or PAP flap allow for less donor site morbidity. Dr Kelley explores these benefits.

Peripheral nerve problems — nerve injuries, painful neuromas, compression syndromes that haven't responded to treatment, and chronic nerve pain — are among the more specialized problems in surgery, and finding the right surgeon can be difficult. Dr. Brian Kelley, a fellowship-trained nerve and microsurgeon in Austin, explains what peripheral nerve surgery covers, why specialized training and experience matter for these microsurgical procedures, what to look for in a surgeon, and how patients and referring providers can find one in Central Texas.

Regenerative Peripheral Nerve Interfaces (RPNIs) for established nerve pain work by giving divided nerves a new target, but relief develops over months, not weeks. The incision heals quickly; the nerve reorganizes slowly. Dr. Brian Kelley, trained at the University of Michigan where RPNI was pioneered, explains the recovery timeline, how nerve perception changes month by month, what imaging shows during healing, and the realistic outcomes and risks based on real evidence.

Breast sensation after mastectomy is typically reduced or absent, and a subset of patients develop chronic post-mastectomy pain. Nerve grafting, allograft, and innervated flap techniques can improve sensation in some patients, but normal pre-mastectomy sensation is essentially never restored. Dr Brian Kelley helps to summarize and explain the latest science.

Lymphedema is a dreaded long-term affect of lymph node dissection in cancer surgery, such as breast cancer. Modern surgical techniques may help to prevent or alleviate those symptoms but surgeons aren't sure what the full utility of these treatments may be. We explore the background and offer our thoughts on when these surgeries might be right for patients.

An overview of the history, latest trends, and controversies shaping breast implants and breast reconstruction. Breast Implants and Implant-Based Reconstruction in Austin, TX

A surgeon's perspectives on DIEP flap breast reconstruction and a patient's journey to healing.