A two-time cancer survivor becomes the first breast reconstruction surgery patient at UT Health San Antonio’s Multispecialty and Research Hospital
At age 72, Gertrude Garteiser faced a pivotal decision.
After undergoing a mastectomy, she had to decide if she wanted to have breast reconstruction surgery. It was a difficult choice. After all, this would mean another major surgery.
More than 25 years earlier, Garteiser had been diagnosed with cancer on her left breast and underwent a lumpectomy, followed by radiation therapy and tamoxifen, a medication that blocks cancer cells from using estrogen to grow.
Then, in October 2024, Garteiser was diagnosed with an estrogen receptor-positive/progesterone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative invasive ductal carcinoma — a type of cancer that begins in the milk ducts. The diagnosis of positive hormone receptors meant that her cancer’s growth was fueled by hormones, and the negative HER2 designation meant that the cancer cells had no or low amounts of HER2 proteins, making them less aggressive.
“The way I found out [the cancer was back] was I felt like something had kicked me in the right breast like a donkey,” Garteiser said. “It was just hurting so bad, so I called and made an appointment at my primary care provider’s office. They had me come in right away and then sent me for a mammogram. But by then, the pain on my right side stopped. I didn’t have that kicked-in-the-chest feeling. I guess it was my body letting me know [something was wrong].”
The mammogram showed cancer recurrence in the left breast. Fortunately, the cancer was discovered early — at Stage 1 — and Garteiser underwent a successful mastectomy on her left breast in January.
Surgeon-patient chemistry matters
After her mastectomy, Garteiser met with several plastic surgeons to discuss breast reconstruction surgery options. Feeling that the chemistry was not quite right, she continued her search and met with Oriana Haran, MD, a double fellowship-trained plastic and reconstructive surgeon at Mays Cancer Center at UT Health San Antonio and assistant clinical professor in the Department of Surgery at The University of Texas at San Antonio’s academic health center.
Garteiser felt a rapport with Haran and scheduled a few more appointments to become more acquainted with the surgeon.
“I just felt comfortable with her,” Garteiser said.
Haran noted the importance for patients to take the time to decide whom they are comfortable with for elective surgery.
“While ‘elective’ means it can be scheduled in advance, it gives you the power of choice,” Haran said. “So, if you are making a choice to have reconstruction, you might as well choose who you’re having the reconstruction with. That’s a critical part of the process. The plastic surgeon is going to hold your hand, not only the day of surgery, but also after. So, you better feel comfortable in front of her or him, you better feel understood 100%. You need that chemistry to feel like you are free to say anything you want to say and not feel intimidated.”
Haran also noted how important it is to have a breast reconstruction surgeon as part of the multidisciplinary team for breast cancer patients, since many breast reconstruction surgeries are performed immediately after a lumpectomy or mastectomy. In Garteiser’s case, since reconstruction was not immediately performed, she could take her time to decide on a path forward.
Understanding surgery options
“Gertrude knew that we were talking about an important surgery,” Haran said. “She was struggling with contour, with symmetry, with her mastectomy scar. She came to me more than once, trying to understand if this was the right surgery for her, if she should proceed with a different procedure.”
Haran discussed the range of options with Garteiser.
“I always say that the options go from no reconstruction at all to reconstruction with [the patient’s] own tissue, which I have always believed offers the best natural result,” said Haran.
After reviewing Garteiser’s pre-operative CT angiogram — which uses X-rays and a contrast dye to create detailed images of the body’s blood vessels — Haran identified that her patient was a strong candidate for a superficial inferior epigastric artery (SIEA) flap procedure. The imaging indicated that her vascular anatomy was suitable for this technique, a finding that would later be confirmed during the surgery itself.
In the SIEA flap procedure, tissue from the lower abdomen is used to reconstruct the breast. A significant advantage of this procedure is that it preserves the underlying abdominal muscles entirely because it relies on the superficial vascular system above the muscle layer, said Haran. This technique can lead to lower risk of abdominal wall weakness compared to other flap procedures.
Since Garteiser had two bouts with cancer and received radiation in the past, the skin on her chest wall needed to be replaced. Using abdominal tissues would be an ideal solution, as it provides both healthy skin to resurface the area and volume to recreate the breast while providing a durable, natural-looking result, explained Haran.
“It’s important to note that not every patient is a candidate for the SIEA flap, as the necessary superficial blood vessels must be of adequate size and quality,” Haran said. For this reason, the deep inferior epigastric perforator (DIEP) flap surgery — which relies on more consistent, deep blood vessels — is the most common and widely regarded gold standard for own-tissue-based breast reconstruction.
Although the SIEA and DIEP flap procedures offer a more natural and durable result, implants remain a viable option for many patients, said Haran. However, implants would not have been a suitable option for Garteiser since the skin on her chest wall was paper-thin after a lumpectomy, radiation and then a mastectomy.
“I constantly would feel my chest where the breast was gone,” Garteiser said. “[It felt] like I was touching my ribs almost, because that’s how much of the tissue was gone.”
Garteiser discussed the surgery with Haran and decided to move forward with the SIEA flap surgery. The surgery was scheduled for Aug. 8, 2025.
First-of-its-kind surgery at new hospital
Garteiser’s surgery marked the first breast reconstruction procedure performed at the UT Health San Antonio Multispecialty and Research Hospital, which opened in December 2024. Among its many offerings, the hospital provides comprehensive patient care, advanced procedures and precision cancer therapies.
Haran herself was uniquely qualified for this procedure, having performed complex microsurgery reconstructions daily during her specialized fellowship at Memorial Sloan Kettering Cancer Center in New York. Thorough by nature, Haran toured the hospital facility twice before the surgery since this would be her first time conducting surgery at this newer location.
“I went downstairs to the instrumentation and perioperative services department and made sure with the operational team that I was going to have everything [I needed],” Haran said. “I visited them and talked to the nurses.” Haran praised the hospital and its staff for their attention to detail.
“The professionalism and preparedness of everyone involved were absolutely vital to the success of this complex procedure,” said Haran. “Having a dedicated team — from instrumentation to nursing — makes all the difference.”
A multistep procedure
On the day Garteiser arrived with her son for her surgery, she was in good hands from start to finish.
The surgery, which lasted about five hours, involved a precise sequence of steps. First, Garteiser’s chest site was prepared to receive the new tissue. Next, the abdominal tissue flap, based on its specific blood vessels, was carefully harvested. The most critical part of the procedure followed, where Haran used microsurgery to connect these tiny vessels to the blood vessels in the chest, restoring immediate circulation to the transferred tissue.
By using the blood vessels that lie above the abdominal muscles, no muscles were cut or disturbed, offering a quicker, more comfortable recovery, Haran said.
After the tissue was placed on the left side of Garteiser’s chest, Haran reduced the size of Garteiser’s right breast and lifted it to achieve symmetry, all in a single procedure. The surgery was successful, but Garteiser’s journey was not yet complete. According to Haran, patients typically need to stay in the hospital for three days after this kind of procedure to ensure the transferred tissue remains healthy and that the patient is mobile and managing pain effectively.
“When we feel that all of the above have been checked, we allow the patient to go home.” Haran said, adding that, in the past, a stay of five days or more was standard for this surgery.
“Now, with improved pain management protocols and enhanced recovery pathways, patients can go home sooner and often require fewer to no opioids. This is a best practice that more hospitals and surgeons are implementing in order to provide faster, improved recovery.”
Feeling good after an inspiring journey
Both Garteiser and her son are appreciative of the hospital care she received before and after surgery. And the surgery itself seemed to be “pretty flawless,” said Garteiser. “I’m very pleased with Dr. Haran and her staff.”
Haran is thankful as well. “I’m deeply grateful for the constant support of our Division of Plastic and Reconstructive Surgery, led by Dr. Anton Fries, for fostering an environment where these kinds of complex reconstructions can truly thrive.”
Now several months beyond her surgery, Garteiser said she’s doing well.
“I feel good,” she said. “And people keep telling me how good I look because I’m relaxing. I feel like it was the right decision.”
Haran is glad that her patient is feeling well.
“Once you are my patient, I feel a deep sense of responsibility through to the end. As surgeons, we can’t and shouldn’t make promises. Things can happen — from infections to anesthetic complications — that are beyond our control. But there is one thing I can truly promise: that I will do my very best to take the best possible care of you, and that my team will, too,” Haran said. “My goal is that you feel listened to and cared for. Even when patients go home, we make sure they’re doing okay. It’s all of those little things that make a difference.”
Haran said she’s glad to have played a role in Garteiser’s inspiring journey. In fact, when the patient and doctor recently met to take a photo together, the gratitude was evident in Garteiser’s eyes. It seemed as if they were longtime friends.
“Breast reconstruction is an add-on that I’m happy to be part of because I think it’s the happy end to the whole story,” Haran said. “I just feel blessed to be part of it.”
To learn more, read “Myth or fact: Breast reconstruction procedures.”