Expert Profile
Olesya Igorevna Startseva – Russian scientist, plastic surgeon, microsurgical specialist, oncologist, Doctor of Medical Sciences, Professor in the Department of Oncology, Radiotherapy and Reconstructive Surgery at Sechenov University. Leading expert in oncoplastic surgery and reconstructive and aesthetic microsurgery of the breast.Education and Career
❖ 1997 — graduated from I.M. Sechenov Moscow Medical Academy with a degree in General Medicine
❖ 1999 — surgical residency at the Russian Scientific Center of Surgery, Russian Academy of Medical Sciences
❖ 2001 – postgraduate studies at RNTsKh RAMS
❖ 2010 – defended doctoral dissertation at RNTsKh RAMS
❖ since 2011 – Professor in the Department of Plastic Surgery at I.M. Sechenov First Moscow State Medical University
❖ since 2018 – Professor in the Department of Oncology, Radiotherapy and Reconstructive Surgery at Sechenov University
Clinical and Scientific Activities
- More than 370 DIEAP reconstructions of the breast
- Approximately 650 microsurgical operations for tissue autotransplantation across various surgical specialties
- Author of more than 300 scientific publications on plastic reconstructive and aesthetic surgery, and co-author of two monographs
- Holder of 7 patents for inventions in reconstructive surgery
- Executive Director of the Academic School of Oncoplastic Breast Surgery, uniting oncologists and plastic surgeons throughout Russia
- Expert of the Surgical Section of the Higher Attestation Commission
- Member of the Russian Society of Oncomammologists (ROOM)
- Member of the Russian Society of Plastic Surgeons (ROPREH)
- Member of the International Society of Aesthetic Plastic Surgeons (ISAPS)
- Member of the World Society for Reconstructive Microsurgery (WSRM)
- Member of the Dissertation Council on Oncology and Plastic Surgery at Sechenov University
Areas of Scientific and Clinical Expertise
❖ Microsurgical tissue autotransplantation
❖ Breast surgery (all types of procedures)
❖ Body contouring
❖ All types of plastic surgery on the body
Professor Startseva actively promotes microsurgical methods, regularly presents at international congresses, and conducts training courses for surgeons from Russia and CIS countries.
Practice Locations:
Moscow
❖ The 1st University Clinical Hospital of Sechenov University
❖ Oncology Center of the 1st City Clinical Hospital named after S.S. Yudin
❖ Scientific and Practical Center in the Hospital Network of Semeynaya Clinics
Breast reconstruction is the surgical restoration of breast shape and volume after mastectomy. Reconstructive procedures can be performed at two different time points: immediate reconstruction occurs during the mastectomy itself, while delayed reconstruction takes place months or even years after completing all cancer treatment. Various factors influence the timing of reconstructive surgery, including medical indications, patient preferences, and healthcare system characteristics, the availability of reconstruction techniques and insurance coverage for such procedures. In the United States, for example, delayed procedures account for approximately 26% of breast reconstructions.
Plastic reconstructive surgeons use several approaches for these operations. Implant reconstruction uses silicone implants (prostheses). Reconstruction using the TRAM flap (Transverse Rectus Abdominis Myocutaneous flap) uses skin, fat, and the rectus abdominis muscle. Today, this method has been largely replaced by the DIEAP method due to significant trauma to the donor site.
The key difference with the DIEAP flap is that the TRAM flap requires removal of the rectus abdominis muscle, which leads to considerable weakening of the anterior abdominal wall, high risk of hernias, and limitations on physical activity. The DIEAP method relies on advanced microsurgical technique: using an operating microscope with 10-20x magnification, the surgeon isolates perforator vessels (1-3 mm in diameter) that pass through the rectus abdominis muscle to nourish the skin and subcutaneous fat. The flap with its "vascular pedicle" is then completely detached, transferred to the chest wall, and the artery and veins are microsurgically connected to the thoracic vessels.
About the DIEAP Flap Reconstruction Method
– What is a DIEAP flap and why is it considered the gold standard for breast reconstruction today?
– DIEAP is a skin-fat flap without muscle. Unlike the TRAM flap, which uses the rectus abdominis muscle, we preserve the muscle completely with minimal trauma. Using high-powered optical magnification, we harvest the DIEAP flap, then perform the microsurgical phase, connecting the flap vessels to recipient vessels in the chest wall under the microscope.
What's crucial is that we're using the patient's own tissue. The reconstructed breast looks and feels completely natural. Interestingly, the tissue we harvest from the abdomen often matches the patient's breast size perfectly.
Usually, this is tissue volume on the abdomen that many women would happily lose. We're essentially combining breast reconstruction with a complete abdominoplasty, which patients would normally pay for as a separate procedure. Such a procedure alone costs between $7,000 and $18,000 in the US.
These results last a lifetime. I have patients with excellent outcomes 15 years after surgery. They can participate in any sport, including strength training and Pilates. I have a whole collection of photos of patients: skiing, weightlifting, practicing yoga.
— For which cases is this method suitable?
— Optimal candidates have a complex defect after mastectomy with sufficient tissue volume on the abdomen. Ideally, the breast is medium or large size. The DIEAP flap is an optimal solution for patients who have undergone radiation therapy, after which implant reconstruction is problematic. We also work with complex cases, we perform secondary reconstructions after unsuccessful procedures with implants.
— What is the average duration of the operation?
— On average, the operation takes 6-8 hours. If it approaches 10 hours, it means there were technical difficulties. We work as a team with colleagues: we prepare the recipient site on the chest wall, isolate vessels, and harvest the flap from the abdomen.
The duration depends on anatomy as well. Sometimes the flap is nourished by one good perforator, then it's faster. Sometimes it's necessary to isolate several small perforators, working around muscle fibers, this is more complex and takes longer. Flap modeling is important and also requires time, as does working with recipient vessels after radiation therapy. After surgery, the patient is up the next day. Discharge is usually on day 5-7, depending on recovery.
— What are the risks?
— There's a risk of flap loss, but with proper technique and sufficient experience, it's minimal. I describe gaining microsurgical experience as building muscle memory. When you perform these operations regularly, at least once a week, outcomes become highly predictable.
Thanks to regular practice and accumulated experience, my success rate today is 100%. The surgeon must understand when to use two vascular pedicles with high body mass index, when to perform venous superdrainage, and how to work with compromised vessels after radiation therapy. You need a clear protocol for managing complications. We monitor flap conditions around the clock during the first days. If blood supply issues arise, the patient returns to the operating room for revision of the anastomoses. We also use indirect anticoagulants in the postoperative period.
— What is needed for successful reconstructive surgery with the DIEAP flap?
— First, you’d need a team. This requires at least two surgical teams, anesthesiologists, and operating room nurses who understand microsurgery specifics. Second, clinical infrastructure with appropriate equipment and facilities: operating microscopes, microsurgical instruments, and the capacity for lengthy operations.
And finally, commitment to the method. You need to believe in the technique, develop the technology, optimize the treatment process, and learn constantly. You can't stand still. Mastering the DIEAP flap transfer technique isn't enough; you need to know how to account for lymphedema, for example, a complication that occurs after mastectomy and radiation therapy in approximately 30% of cases. In such situations, we perform lymphovenous anastomoses and even lymph node transplantation.
Path to Microsurgery
– Как вы пришли в микрохирургию? Это нетипичное направление для хирурга и тем более для пластического хирурга.
— How did you get into microsurgery? This is an unusual direction for a surgeon, especially for a plastic surgeon.
— My story began in my third year of medical school, in the mid-90s. It was a very contradictory period for microsurgery in Russia. On one hand, I saw microsurgery at the end of its Soviet-era heyday: fashionable, cutting-edge, the dream of many surgeons. On the other hand, I watched it all collapse.
To understand what happened, you need to know the context: microsurgery in the USSR developed in a unique way. In 1976, Health Minister Boris Vasilyevich Petrovsky issued an order to create a system of microsurgical care. It was a massive, centralized infrastructure. The main center was the Russian Scientific Center of Surgery, with microsurgery departments created in every major city, and each Soviet republic had its own centers. Everything was highly organized and coordinated. People came for training and completed dissertations.
The period from 1976 to the late 80s was the golden age of Soviet microsurgery. The first limb replantations, flap transfers. These operations drew huge media coverage. These were unique operations of world-class caliber. I remember this case of a girl whose legs were severed by a lawnmower: the replantation was done at RNTsKh by a team of surgeons from different countries.
But by my third year, in 1995-96, the whole system had already collapsed. When the USSR fell, the whole infrastructure fell apart: who would pay, who would coordinate, how to transport patients? Everything was held together only by the dedication of individual surgeons.
— And that's when you decided to pursue microsurgery?
— Yes, it was precisely at this difficult moment that I learned about the emergency microsurgery department at Hospital 71 on Mozhaisk Highway. I learned from colleagues, young doctors who were already working there. I was an ambitious student. I'd earned my place at medical school through merit, with clear ambitions. And when I heard about microsurgery, I thought: that's it, that's what I want to do.
But the reality was far from romantic. I got a job there as an OR nurse, just to be close to the action, to help and observe operations. The shifts were brutal. Back then, we saw a lot of hand injuries: circular saws, industrial accidents. I even remember thinking someone should outlaw circular saws.
Picture this: a patient comes in with three severed fingers. Each finger replantation takes about three hours. Three fingers, that's nine hours of surgery. And I'm doing all this while still in medical school. I had entered the honors track, where top students were selected after third year, and there I had to write a thesis and choose a research advisor.
There were moments I wondered if I could handle emergency surgery. Physically exhausting, emotionally draining. Endless fingers, hands, replantations... I didn't realize there was another side to microsurgery.
— How did this become clear?
— It happened by chance. I stayed late one day, and someone mentioned there'd be a planned operation. Professor Ruben Tatevosovich Adamyan was coming in to do a flap transfer. It was a young man with severe burns to his hand and genitals from an electrical injury: he'd urinated on a live wire. The hand was treated in-house, but they called in Professor Adamyan for the reconstruction.
That's when I realized what microsurgery could really be, watching Adamyan perform his signature phalloplasty technique: this is what I'd been looking for! It turns out microsurgery wasn't just finger reattachments. There was also planned surgery, flap transfers, delicate reconstructive work. That delicate work under the microscope—that was what I'd imagined surgery could be.
I tracked down where Adamyan worked, the Russian Scientific Center of Surgery, named after B.V. Petrovsky, at the Russian Scientific Center of Surgery named after B.V. Petrovsky, in the department of reconstructive microsurgery under the leadership of Academician Nikolai Olegovich Milanov. Milanov worked with legendary surgeons, strict, stern academics.
But here's what you need to know about that era and that institution: with everyone else he was stern, but not with students. At Moscow Medical Academy, students were never told "no." Every idea, no matter how crazy it seemed, was encouraged. This was the old school, cultured intellectuals, and it was a privilege to study there.
So I had to figure out how to get to him. I worked my connections, got one professor to introduce me to another, helped write papers and draw illustrations. I earned my way in. That's how I eventually worked up the nerve to ask him to be my thesis advisor.
He looked at me and said, “Alright then, let's see what you've got.” He gave me a topic related to Adamyan's work, something challenging but doable for a student, a literature review. I studied Adamyan's doctoral dissertation: there were 12-14 patents, extensive work; wrote a continuation as a review, defended my thesis, and asked to enter residency.
— When did you master the DIEAP flap technique?
— In 2008, Boris Lvovich Shilov, one of Milanov's former students who was working in Germany at the time, set up an opportunity for me to observe operations with Professor Axel-Mario Feller in Munich. I went with a graduate student, spent two weeks there, and returned completely inspired. We formed a surgical team and in October 2009 did the first DIEAP flap transfer in Russia at RNTsKh.
Early on, when we were pushing the DIEAP technique, we faced criticism: "Why go to all that trouble? You can do it without a flap, and you can use a TRAM flap!" But we believed in the method. You could see Nikolai Olegovich's vision in everything he did. He said, "Do it. You're young. Take this forward'." And we pushed through that resistance.
The early adopters of the DIEAP flap were young surgeons, including Dmitry Vladimirovich Melnikov. We did all the cases together, backed by our mentors. We gave countless presentations on DIEAP flaps. I alone gave 60, plus additional ones from Dmitry Vladimirovich. Everywhere possible: conferences, symposia, courses. Gradually, people came around. The statistics now show we were right all along. DIEAP flaps are now one of the most common microsurgical procedures worldwide, and are becoming so in Russia.
Scaling Experience
— How many microsurgical operations in total have you performed to date?
— I've done 372 DIEAP flap breast reconstructions. But I've worked across multiple areas. A good microsurgeon needs to be versatile.
From 2000 to 2004, I did 240 microsurgical procedures in urology. From 2004 to 2007, I worked in maxillofacial surgery, doing 39 operations. Since 2008, my primary focus has been breast reconstruction, but I continue urogenital microsurgery.
In total, about 650 microsurgical operations for flap transfer. If I counted every anastomosis I've sutured, we'd be talking thousands. But it depends on what you're counting. Did I just suture the anastomosis? Did I harvest the flap? Did I do both? Did I manage the postop care too?
Since residency, I progressed from assisting, to suturing anastomoses while others harvested, to doing both. But if we're being honest about counting, I'd say 650 to 700 cases where I was leading the surgery.
— You are also an oncologist. How important is this for surgical success?
— Working at the intersection of different specialties, I realized I needed to master the oncology side too. I obtained board certification in oncology and now work in the oncology department at N.N. Blokhin National Medical Research Center of Oncology, which allows me to operate on patients through government-funded programs.
So now when I'm doing breast reconstruction, I'm operating as both a microsurgeon and an oncologist. It gives me a 360-degree view of the treatment: I understand the cancer diagnosis, prognosis, and how chemotherapy will affect things, so I can plan whether to do immediate or delayed reconstruction.
— What is the situation with accessibility of these operations in Russia?
— The technique is spreading, and more and more surgeons are learning it. New centers are opening up: at P.A. Herzen Moscow Oncology Research Institute now has two departments doing DIEAP flaps, with the second department starting just two years ago and already catching up with the first.
At the First Oncology Center of S.S. Yudin City Clinical Hospital, together with Maria Vladimirovna Ermoshchenkova, MD, PhD, Professor in the Department of Oncology, Radiotherapy and Reconstructive Surgery at Sechenov University, we’ve established and support the Academic School of Oncoplastic Breast Surgery, where we teach oncologists and plastic surgeons how to do reconstruction. St. Petersburg's Petrov Cancer Center is doing excellent work too.
In Moscow, more teams are forming, and private clinics are getting into microsurgery too. Sechenov has two teams running these procedures, one in the Plastic Surgery Department, one in the Oncology and Reconstructive Surgery Department.
— How does the international community evaluate Russian experience?
— When it comes to breast reconstruction and microsurgical techniques, we're now at the same level as Western teams. In the 90s and early 2000s, we learned from Western colleagues and basically followed their lead. Over the last decade, things have balanced out. Now we're actually training surgeons from other countries. Surgeons come from the Middle East, China, and former Soviet states to learn from us. They look up to us just as we once looked up to Europeans.
I speak at international congresses, and we organize our own symposia on reconstructive microsurgery. For the past ten years, we have been holding the congress "Current Issues in Microsurgery in Memory of N.O. Milanov."
We do see medical tourism, patients coming from abroad to have surgery with us. People come from China, former Soviet republics, places where these techniques either don't exist or cost way too much.
1. How much time is needed for recovery after DIEAP reconstruction?
➢ Hospital stay: 5-7 days
➢ Light duties and office work: 2-3 weeks
➢ Full recovery: 2-3 months
2. Will scars be visible?
The abdominal scar is located along the bikini line and is usually well hidden under underwear. On the breast, scarring depends on the type of mastectomy. With modern skin-sparing techniques, scars are minimal.
3. Is it possible to do DIEAP reconstruction years after mastectomy?
Yes, delayed reconstruction is possible any time after mastectomy, even after 5, 10, or 15 years. The main requirements are sufficient volume of donor tissue and optimal overall health.
4. Is it possible to fly on an airplane immediately after reconstruction?
Once healing is complete, there are no restrictions. For the first 4-6 weeks, we recommend avoiding long-haul flights.
5. Is special preparation for surgery needed?
Yes, standard preoperative preparation includes:
➢ Testing (blood work, ECG, CT/ultrasound of abdominal vessels)
➢ No smoking; you have to stop at least 4 weeks before
➢ Weight management if necessary
➢ Check with your doctor about stopping any blood thinners
6. What are the risks of flap rejection?
An experienced surgeon brings the flap loss risk down to 2-3% or less. If vascular issues develop, we go straight back to the OR for revision. If for some reason the flap fails completely, we can do reconstruction using another approach.