Breast Reconstruction

Dr. Shenaq is passionate about breast reconstruction. Known throughout Houston and the surrounding area as a breast reconstruction specialist, Dr. Shenaq is the surgeon many doctors refer their patients to for the restoration of their breasts.

Dr. Shenaq expertise covers many techniques. Below are some of the more commonly used techniques Dr. Shenaq employs.


Whole + Well

"I am thrilled with the outstanding results of my bilateral reconstruction surgery! Dr. Shenaq is an exceptionally skilled plastic surgeon. My surgeries were performed as carefully and with such expertise that the end result looks more like an augmentation than a reconstruction. The scars are hidden and the reconstructed breasts look and feel so natural. They are beautifully shaped and in excellent proportion with my physical build."

- Susan, Breast Reconstruction Patient

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1 - DIEP (deep inferior epigastric perforator) flap reconstruction is an advanced technique used in breast reconstruction after mastectomy in which excess abdominal skin and fat are removed from the lower abdomen to reconstruct the breast. In DIEP flap reconstructions, the blood vessels are safely separated from the muscle using microsurgical technique while preserving the muscular integrity. Abdominal tissue is completely detached from the abdomen with its blood vessels and reattached to the small blood vessels in the breast area using vessels between the ribs resulting in a microsurgical transfer. These very small blood vessels require the surgeon to use a microscope in order to connect the blood vessel together. Once this is complete, the flow of the blood to the tissue is restored. The tissue is then shaped to form the new breast. The skill of the surgeon in breast flap reconstruction is considerably more demanding than the previous earlier methods of breast reconstruction. The procedure is less invasive than previous methods resulting in less postoperative pain and faster recovery. Also the procedure leaves a horizontal scar on the lower abdomen similar to that created in abdominoplasty (tummy tuck) resulting in a more pleasing abdominal contour that is appreciated by most women.

2 - SIEA (superficial inferior epigastric artery) flap reconstruction where the difference from the DIEP flap reconstruction that the blood vessels are more superficial and they travel in the fatty parts of the abdominal tissue. Therefore it requires less dissection, but usually the blood vessels are very small and not all patients are candidates for this procedure.

3 - SGAP (superior gluteal artery perforator) flap reconstruction is ideal for those who do not have enough amount of excess abdominal tissue then the breast might be reconstructed from fat and skin taken from the upper part of the buttock area. This is done without sacrificing the underlying gluteal muscle. A similar procedure called the IGAP also uses the tissue from the lower part of the buttock, but in this case will use different blood vessels, that is why the name is called inferior gluteal artery perforator flap. Both procedures are considerably more demanding and lengthy because it requires the surgeon to change the position of the patient during surgery, but at the end it will leave the patient with autologous tissue transfer.

4 - TRAM (transverse rectus abdominus myocutaneous) flap in which the lower abdominal skin and fat are transferred to the breast area by keeping the tissue attached. This procedure requires sacrifice of the rectus muscle and is more invasive and might leave the patient with lower abdominal bulge or hernia. Candidates for this procedure often opt for the DIEP flap in order to preserve the rectus muscle and avoid future abdominal complications.

5 - Latissimus flap reconstruction where this is not a microsurgical reconstruction, it utilizes the latissimus dorsi which is usually the muscle on the back with the fat overlying it and dissecting it with a skin paddle rotating it in order to cover the breast tissue area. This flap, usually used in combination with either tissue expander or an implant because of the limitation of the amount of tissue transferred in order to form enough breast tissue in that area. It leaves the patient with the scar on the back and usually used as a second or third option if the previous options are not available.


Breast reconstruction with tissue expander/implant. This is a common breast reconstruction technique which involves expansion of the breast skin and muscle using a temporary tissue expander (an inflatable implant designed to stretch the skin and the muscle) to make space for a future more permanent implant. Two to three months later, after completion of the expansion process, which is done in the office, then the expander is exchanged with a permanent implant. The implant can be either silicone or saline. Although this technique requires two small separate surgeries, it is less invasive than other procedures and has a faster recovery. The process of expansion usually begins two to four weeks after mastectomy. Expansion continues until the desired size is achieved.


The main goal of breast reconstruction is ultimately to restore breast shape, size and symmetry in order to achieve an aesthetically pleasing outcome. Additional procedures to obtain symmetry may be necessary after the original reconstruction in order to ensure the reconstructed breasts are as close as possible in shape, size, and position of the nipples. All the symmetrical procedures are usually done dependent upon the patient, whether they initially underwent unilateral (one side breast reconstruction) or bilateral breast reconstruction. Of the secondary procedures:
1) nipple reconstruction usually required in the patient who had nipples removed during mastectomy
2) breast augmentation, often done on the opposite side to gain symmetry
3) breast lift/breast reduction
4) fat grafting – which is autologous fat transfer to the breast. Usually, the fat is harvested with liposuction techniques from the abdomen, flanks or the thighs. Then, through a special process filtering the fat cells that are believed to be live cells, are transferred and implanted through a special technique into the breast. This is usually done, as a secondary procedure, in combination with implant reconstruction or partial breast deformity, after lumpectomy, or a previous flap surgery. This is done as an outpatient procedure and recovery is fast.

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"My family and I have so much to be thankful for and celebrate – and it is all because of you. You made it all possible. We will be grateful to you forever. Your skill and brilliance as a surgeon is apparent. You made me whole again, in body and spirit. I cannot thank you enough for your kindness and compassion; for your care and sincere concern. You're an amazing doctor and beautiful soul."

Jamie, Breast Reconstruction Patient

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