Welcome to Pierre Chevray, MD, PhD
Breast Reconstruction, Houston, TX
Breast reconstruction or breast restoration is a delicately-balanced combination of both cosmetic and reconstructive surgery. This intricate procedure combines art and science, down to the most-minute detail. Board-certified plastic and reconstructive surgeon, Dr. Pierre Chevray, embraces this specialized niche as his area of expertise. With over 1,000 breast reconstruction procedures to his credit, Dr. Chevray’s experience in this arena is unsurpassed.
Dr. Chevray’s committed journey with breast reconstruction took on an added dimension at Houston’s M.D. Anderson Cancer Center. Dr. Chevray’s 8 years as a faculty member at this world renown cancer hospital paved the way towards his recognition for having performed more breast reconstruction surgeries than any other plastic surgeon there. Dr. Chevray continues to specialize in breast reconstruction at the Methodist Hospital System in the Houston Medical Center, and in Sugar Land, where he employs the DIEP, SIEA, TRAM, IGAP and SGAP free flap methods, in addition to more traditional tissue expander and breast implant methods.
Dr. Chevray fully understands a woman’s emotional involvement with any type of breast surgery; and what helps, greatly, is his wealth of experience, knowledge and caring bedside manner that puts his patients at ease. His reputation as being gentle and approachable, precede him.
The photo pages of this website reflect some of Dr. Chevray’s intricate and technically demanding surgical work that results in excellent cosmetic and reconstructive outcomes for breast reconstruction. Additionally, some of his peer-reviewed scientific publications which attest to his academic leadership in the field are listed below.
Important Things to Know
Breast reconstruction can be accomplished in one of three ways, using:
- Autologous tissue flaps from the lower abdomen or back
- Prosthetic breast implants, or
- A combination of flaps and implants.
It is important to note that autologous tissue flaps from the lower abdomen, such ast DIEP, SIEA, and TRAM flaps are especially conducive to achieving the best shape, softness, movement and warmth of a natural breast. Breast implants, on the other hand, are generally not as good at reconstructing as natural a breast.
With that being said, there are several important considerations one should be aware of when comparing the lower-abdominal (DIEP, SIEA, and TRAM) flap method to breast implants. With the lower-abdominal flap method, one should expect longer surgical time, a longer hospital stay, increased recovery time and some donor-site morbidity at the lower abdomen.
Procedures for harvesting the lower abdominal flap for breast reconstruction have evolved over the past 20 years, and the goal has always been to reduce, as much as possible, the amount of rectus abdominus muscle and facia that accompany the flap when it is harvested. The reason for this is to minimize donor-site weakness, pain, and morbidity. The various techniques that are used include:
– Pedicled TRAM (pTRAM) flaps which involve removal of all of the rectus abdominis muscle and a lot of fascia
– Free TRAM (fTRAM) flaps which involve excision of a muscle segment and fascia in free TRAM flaps
– Muscle-sparing free TRAM (msTRAM) flaps which involve removal of a plug of muscle and a small amount of fascia
– DIEP flaps in which the muscle and fascia are incised, but not excised.
– SIEA flaps in which the muscle and fascia are neither incised, nor excised
One thing the fTRAM, msTRAM, and DIEP flaps have in common is the removal of the deep inferior epigastric artery which, very importantly, provides the main blood supply to the rectus abdominis muscle. As a result, donor site morbidity cannot be entirely prevented. Donor site morbidity, in these cases, can include belly muscle weakness, pain, and risk for bulge or hernia formation.
The SIEA flap, like the TRAM and DIEP flaps, does include the same flap of lower-belly skin and fat, but does not involve an incision or excision of rectus abdominis muscle, anterior recutus fascia or the deep interior epigastric artery. In the end, the SIEA flap procedure allows for the virtual elimination of abdominal donor site weakness, abdominal bulging , and hernia formation.
There has been much debate in medical literature, which includes several scientific articles by Dr. Chevray on the subject. It is now generally accepted that DIEP flaps cause less donor site morbidity than muscle-sparing TRAM flaps, and that muscle-sparing TRAM flaps cause less donor site morbidity than free TRAM flaps. However, this difference is not clinically significant when only one flap is used from the abdomen. When two flaps are used for the abdomen, such as when reconstructing a double mastectomy, the DIEP flap causes noticeably less donor site morbidity than the free TRAM flap. The SIEA flap harvest imparts even less abdominal donor site morbidity than even the DIEP flap.
Qualifications for TRAM, DIEP, and SIEA Flaps
Dr. Chevray makes it very clear who is, or is not, a viable candidate for breast reconstruction using TRAM, DIEP and SIEA Flaps. The following points are important:
- Prior chemotherapy or chest wall radiation does not disqualify one from breast reconstruction using a TRAM, DIEP, or SIEA flap. However, prior radiation does disqualify patients from breast reconstruction using only a breast implant. As one might expect, the cosmetic result of breast reconstruction is somewhat compromised after radiation; but 6 months after the completion of radiation treatments, Dr. Chevray will commence with breast reconstruction surgery.
- Once any chemotherapy is completed, Dr. Chevray prefers a 1-month wait before initiating breast reconstruction surgery in order to allow one’s white-blood cell count and immune system to recover and become more normalized.
- Studies published by Dr. Chevray, and others, show that obesity does not increase the risk for loss of TRAM, DIEP or SIEA flaps, but does increase the risk of healing complications, as well as increasing the surgery time.
- Smoking increases the risk of complications of all types of breast reconstruction surgery. Active smokers should stop altogether, or abstain a minimum of 2 weeks before and after surgery. It is not uncommon for surgeons to postpone surgery until smoking has stopped. Some surgeons even test for
nicotine levels in urine to ensure the patient has not been smoking. Dr. Chevray understands that it is very difficult to quit smoking, especially during the stressful time surrounding the diagnosis of breast cancer. Therefore, Dr. Chevray offers breast reconstruction surgery to patients who smoke, as long as they understand and accept that the risk of complications, such as poor or delayed wound healing, fat necrosis of flaps, or exposure and infection of breast implants is significantly higher in smokers when compared to non-smokers.
- Prior abdominoplasty precludes breast reconstruction with TRAM, DIEP or SIEA flaps.
- Prior liposuction of the belly decreases the reliability of an TRAM, DIEP and SIEA flaps. Therefore, Dr. Chevray recommends using a muscle-sparing free TRAM flaps for patients with previous abdominal liposuction.
- TRAM, DIEP or SIEA flap procedures are, typically, not safe to perform in patients with conditions that include heart failure, chronic obstructive pulmonary disease or previous heart bypass surgery.
Four Key Points about Breast Reconstruction
Dr. Chevray makes a point of familiarizing each of his patients with four vital points:
1: The realistic goal of breast reconstruction is providing patients with outward normalcy when wearing regular clothing. It should be evident to no one that one of Dr. Chevray’s patients has had mastectomy surgery.
As expected, without clothing, one may notice variations in the coloration, shape, overall contour, and symmetry between a reconstructed breast and a natural, normal, breast. However, if a patient has a nipple-sparing mastectomy, Dr. Chevray can often reconstruct a breast that looks like a normal, natural, breast.
2: One should expect 2 surgeries to complete all breast-reconstruction procedures, regardless of which method is used. The vast majority of Dr. Chevray’s patients undergo 2 or more surgeries to complete breast reconstruction.
Operation #1 – typically incorporates unilateral or bilateral breast reconstruction with TRAM, DIEP or SIEA flaps, or a implant tissue expander, and includes a 2 to 4 night stay at the hospital.
Operation #2 – is performed 3 or more months after the first surgery, and is an out-patient procedures that could include nipple reconstruction or optimizing the shape, size, position, and/or symmetry of the reconstructed breast or breasts. Various procedures such as augmenting, reducing or lifting could be employed.
3: Breast surgery includes the small risk – a several-percent chance – of failure, regardless of which procedure is utilized: implant, TRAM, DIEP or SIEA flap.
4: Breast reconstruction is a personal choice. Each patient will decide whether to have breast reconstruction, and which method best fits her lifestyle, desires, and expectations. Foregoing breast reconstruction altogether can be embraced every bit as much as one choosing to undergo breast reconstruction. If no surgeries are opted for, an external breast prosthesis can be used as an alternative to surgery. That same patient may change her mind and choose to undergo breast reconstruction months or years after a mastectomy has taken place.
Many patients are pleasantly surprised to learn that health insurance covers not only the initial breast reconstruction, but secondary surgery, as well. Insurance companies view breast reconstruction as an integral component of breast-cancer treatment, as explained in The Women’s Health and Cancer RightsAct of 1998. This federal law stipulates that commercial health insurance companies that cover treatment for breast cancer are obligated to, also, cover breast reconstruction. By law, insurance coverage for breast reconstruction cannot exclude surgery on the opposite breast which may take place in order to optimize breast symmetry.
Give Us A Call
To learn more about Dr. Chevray and his areas of surgical expertise, we encourage you to visit the rest of our website. You will find additional information regarding plastic surgery procedures, breast reconstruction, cosmetic surgery, reconstructive microsurgery and more.
Give us a call at: 713-441-0714 – the answers to your questions are only a phone call away. We can schedule a personalized consultation with Dr. Chevray who will address your needs, concerns and goals.
Over the past decade, Dr. Chevray’s practice has been strongly focused on breast surgery. Patients from the Houston area and beyond come to see Dr. Chevray for breast surgery solutions such as: