Middle East Health speaks to Dr Dmitry Melnikov, plastic and reconstructive surgeon, about breast reconstruction following mastectomy due to breast cancer. Dr Melnikov is the Russian National Vice Secretary for the International Society of Aesthetic Plastic Surgeons (ISAPS) and an active member of the World Society of Reconstructive Microsurgery.
Middle East Health: Two advanced breast reconstruction procedures are Superficial Inferior Epigastric Artery flap and Deep Inferior Epigastric Perforator flap. Can you tell us about them and how they differ?
Dr Dmitry Melnikov: Superficial Inferior Epigastric Artery (SEIA) and Deep Inferior Epigastric Perforator (DIEP) flaps are cutting-edge breast reconstruction procedures that use a woman’s own tissue to create new breasts after a mastectomy due to breast cancer.
Similar to a DIEP flap, a SIEA flap involves moving a different section of blood vessels with fat and skin from the belly. While a DIEP flap requires a minor incision in the abdominal fascia – the casing of organ. A SIEA flap is a less intrusive form of surgery that doesn’t require an incision.
The DIEP flap is the most advanced form of breast reconstruction, offering patients a natural looking and feeling breast. It is a major surgery that requires general anaesthesia.
Middle East Health: Beyond aesthetics, how does this surgery boost women’s morale?
Dr Dmitry Melnikov: Given its nature, a DIEP flap somehow restores original body tissue, returning a big part of ‘lost femininity’ due to cancer and mastectomy. It boosts the morale of female patients, who view their breasts as a vital aspect of their lives as females.
Middle East Health: How difficult is this type of surgery?
Dr Dmitry Melnikov: The DIEP flap procedure involves suturing vessels as thin as the human hair. Therefore, it requires special training and equipment. Locating the vessels and harvesting the flap without damaging the donor area requires precision and meticulous attention to detail.
Middle East Health: How many surgeons specialize in this kind of surgery globally?
Dr Dmitry Melnikov: Under 1,000 doctors globally are qualified to perform this surgery.
Middle East Health: When was the first time you performed this procedure?
Dr Dmitry Melnikov I performed the first SEIA flap in Russia in 2016, the first DIEP flap in Uzbekistan in 2019, and the first DIEP flap in Latvia in 2020. In total, I have so far performed hundreds of these surgeries over the past 10 years.
Middle East Health: What is the level of awareness among women about this kind of surgery?
Dr Dmitry Melnikov: The level of awareness about this surgery in developed countries is moderate. Actress Shannon Doherty has undergone this type of breast reconstruction, and she shared her journey on social media. There is still a lot to be done in raising awareness in the field of reconstructive surgery in general.
Middle East Health: What is required to perform this procedure in other countries?
Dr Dmitry Melnikov: Having built a strong team, I am able to perform this type of surgery in practically any medical facility, provided it has a microscope and can provide post-surgery support for the patient.
To save time and for the patient’s comfort, the procedure is done through a medical crew working simultaneously. Two surgeons would be harvesting the flap from the donor area while two others close that area and two more prepare the recipient area, suturing the arteries and veins and then shaping the breast. It’s crucial to minimize the surgery time as this has been reported as a contributing factor to the surgery’s complication rate.
Middle East Health: Do you have any plans to expand to the UAE?
Dr Dmitry Melnikov: Expanding to the UAE is our number one priority. We are in talks with major medical centres in Dubai that we intend to collaborate with. My mission is to bring the procedure to all corners of the globe including developing countries.
Middle East Health: How do you assess the level of demand for this surgery globally?
Dr Dmitry Melnikov: The demand for this type of surgery has been growing over the past decade thanks to patient support groups. Patients tend to stick together to share their experiences and help one another as it’s difficult to walk this journey alone. According to recent statistics, one in eight women will be diagnosed with breast cancer during their lives, signifying the importance of DIEP and SIEA flaps for the mental and physical wellbeing of women globally.
