WATCH: Breast Reconstructive Surgeon Explains How Physician-led Problem Solving Can Transform Surgical Practice

In the latest episode of Houston Methodist's Women in Surgery series, breast reconstructive surgeon Dr. Aldona J. Spiegel joins Houston Methodist Chief Physician Executive Dr. Shlomit Schaal to discuss how listening to patients and embracing calculated risk can transform surgical practice.

From art to surgery: A lifelong vision

Dr. Aldona Spiegel's career trajectory was set early. "At the age of 13, I decided that I wanted to be a plastic surgeon," she recalls. Her passion for art and medicine converged in reconstructive surgery — a discipline requiring both technical mastery and aesthetic judgment.

Today, Dr. Spiegel serves as chief of the Division of Surgical Innovation at Houston Methodist, leading advancements that redefine patient care.

Transforming breast reconstruction through microsurgery

Initially trained in general surgery, Dr. Spiegel pursued microsurgery — a technique that enables autologous tissue transfer by connecting vessels as small as two millimeters.

"Microsurgery particularly appealed to me because it is a mix of art and very specific technical technique," she explains.

This interest led her to adopt and champion the deep inferior epigastric perforator (DIEP) flap procedure, a muscle-sparing microsurgery technique that uses a patient's abdominal skin, fat and blood vessels to reconstruct the breast after mastectomy. "I really, really believed that preserving [abdominal] muscle was important for patients," she says.

Today, this approach is widely accepted as standard of care.

Restoring sensation: Meeting an overlooked need

Dr. Spiegel identifies another challenge patients go through in their breast reconstruction journey: loss of sensation in the reconstructed breast. "Patients didn't even know they would lose sensation," she notes. In the medical field, she notes that this wasn't necessarily something that other surgeons thought was important. "They thought there was enough sensation that kind of grows in," she adds.

The "light bulb moment" for restoring sensation came after one of Dr. Spiegel's patient sustained a second-degree burn on her reconstructed breast — not having the protective sensation necessary to recognize boiling water had splashed onto her chest.

So Dr. Spiegel started re-connecting nerves during microsurgery, too. Initially met with skepticism, her advocacy for neurotization has gained traction, and restoring sensation is now an emerging benchmark in breast reconstruction.

And this isn't her first innovation to originate from patient feedback. "One of the important things is really to listen to the patient, because the patients will keep on raising the bar if you listen to them," adds Dr. Spiegel.

Innovation rooted in patient needs

Dr. Spiegel shares a message to peers: innovation is not a luxury — it's a responsibility. "If you start with the need, you can move the entire field forward," she affirms.

This philosophy inspired her to redesign acellular dermal matrix for direct-to-implant reconstruction, eliminating the need for tissue expanders. "I had experience in sewing — I made my own prom dress in high school," she explains. "Thinking back — of a two-dimensional material being made into a three-dimensional corset — years later made me think, how can I make this so that women don't have to have a tissue expander?"

The result: a patented design now used in the U.S. and Australia.

"It was really at an amazing time because it occurred right before the COVID [pandemic] and it allowed patients to have direct-to-implant reconstruction without having a tissue expander, which decreased the need to stay overnight. And so many more patients were able to have a mastectomy without sort of a temporizing lumpectomy to have that direct-to-implant reconstruction," she adds.

Leading surgical innovation

As chief of Surgical Innovation, Dr. Spiegel fosters a culture of physician-led problem solving. "Best innovation happens when you first think of the need and when you can craft the need into one that you feel like that's most impactful," she explains.

Her team is currently developing resorbable 3D-printed scaffolds to stimulate endogenous tissue growth — a potential third pathway beyond implants and autologous flaps. To formalize this approach, Dr. Spiegel trained at Stanford Biodesign and launched Houston Methodist's first biodesign program.

"It brought together physicians and researchers and engineers … and that was really exciting," she says.

Balancing career and life: A realistic perspective

Dr. Spiegel offers candid advice on work-life integration. For women in surgery, she underscores prioritization: "You're juggling a lot of balls. You have your professional career, you have so many other things and you have your family. And the one is unlike the others, which are ones you can drop — the family one is the one that's made of glass. You should never drop that one."