UZ Brussel achieves world first in breast reconstruction by combining two surgical robots
UZ Brussel has reached a new milestone in the field of reconstructive breast surgery. On 4 February 2026, an interdisciplinary team led by Prof. Moustapha Hamdi performed, for the first time, a bilateral breast reconstruction using autologous abdominal tissue, combining two surgical robots in a single operation. According to current scientific knowledge, this combination of techniques has not previously been applied within one and the same procedure.
This milestone marks the start of a structured clinical programme for this type of reconstruction at UZ Brussel. The programme builds on existing expertise in robot-assisted microsurgery, now applied for the first time to autologous breast reconstruction.
The procedure was performed on a patient following a double mastectomy due to breast cancer, in close collaboration between the departments of plastic and reconstructive surgery, abdominal surgery and oncological surgery. The patient is recovering well.
A less invasive approach with direct benefits for the patient
In a conventional DIEP flap reconstruction, skin and fatty tissue from the lower abdomen are used to reconstruct the breast. To access the blood vessels, the abdominal wall must be opened over a relatively large section of the abdominal muscle. This may result in post-operative pain, a risk of abdominal wall weakness and a longer recovery period.
This new approach uses a less invasive technique. With the Da Vinci Xi robot, surgeons were able to dissect the blood vessels from within the abdomen, significantly reducing the size of the incision. The reconstruction was then completed using the Symani microsurgical robot, which enables highly precise vascular anastomoses.
Based on current knowledge, UZ Brussel is the first centre to combine both systems in a single DIEP flap procedure, and to do so immediately in a bilateral reconstruction.
Prof. Moustapha Hamdi, Head of the Department of Plastic and Reconstructive Surgery: “By combining these two technologies, we reduce the impact on two levels: the impact on the abdominal wall and the complexity of the microsurgical phase. This potentially means less pain, a lower risk of abdominal wall complications and a faster recovery. This is particularly relevant in bilateral breast reconstructions, where conventional surgery requires more extensive procedures on both sides of the abdomen. The patient was therefore able to leave the hospital earlier than is typically the case.”
Towards a structured clinical programme
This first procedure forms the basis for the development of a structured clinical programme at UZ Brussel. The technique is intended for patients eligible for breast reconstruction using their own tissue, provided their anatomy is suitable. This is assessed in advance using preoperative imaging.
A prospective study is being prepared to systematically evaluate outcomes.
Interdisciplinary collaboration as a foundation
The procedure was performed by an interdisciplinary team representing three surgical disciplines: plastic and reconstructive surgery (Prof. Moustapha Hamdi, Head of Department, Prof. Alexandru Nistor and Dr Ayush Kapila), abdominal surgery (Dr Ellen Van Eetvelde) and oncological surgery (Prof. Marian Vanhoeij).
The operation was prepared as part of an international masterclass organised by the department, in close collaboration with Prof. Jesse Selber (MD Anderson Cancer Center, Houston, USA), a pioneer in robot-assisted DIEP flap surgery.
Prof. Jesse Selber: “A major drawback of this type of breast reconstruction has always been the impact on the abdominal wall, as the blood vessels had to be dissected through the abdominal muscles. Over time, this could lead to weakening or bulging of the abdomen. With robotic assistance, we can now isolate these vessels much more precisely while preserving the muscles. This makes a significant difference in patient recovery and comfort.”
Building further on expertise in robotic and microsurgery
“After more than 2,000 DIEP flap reconstructions using the conventional technique, we know this method is reliable. However, we must continue to innovate. The introduction of robotic surgery allows us to push the boundaries and further reduce the impact of surgery on the patient, without compromising on quality,” says Prof. Moustapha Hamdi.
Prof. Alexandru Nistor adds: “This procedure builds on our experience in robot-assisted microsurgery, including the treatment of lymphoedema. Its application in breast reconstruction is a logical next step. Close collaboration with abdominal surgery is essential to safely and consistently integrate this technique into clinical practice.”
This combined robotic DIEP flap procedure is part of the ongoing development of robot-assisted microsurgery at UZ Brussel. The Department of Plastic and Reconstructive Surgery has previously introduced several innovations, including robot-assisted lymph node transfer (2018), lymphaticovenous bypass surgery (2023), and the combined use of the Da Vinci Xi and Symani systems (2024). In 2025, the milestone of 100 lymphoedema patients treated with the Symani robot was also reached.
Karolien De Prez