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4. The Preferred Design of the Profunda Artery Perforator Flap for Autologous Breast Reconstruction: Transverse or Diagonal?

Author

Zack Cohen, MD, Saïd C. Azoury, MD, Jonas A. Nelson, MD, MPH, Kathryn Haglich, BS, MS, Joseph H. Dayan, MD, MBA, Evan Matros, MD, MMSc, and Robert J. Allen, Jr, MD

Subjects
Surgery, RD1-811
Abstract

Background:. Since its introduction for autologous breast reconstruction in 2010, the profunda artery perforator (PAP) flap has emerged as a preferred choice when an abdominal flap is suboptimal. The traditional transverse design (tPAP) was popularized, given the inconspicuous donor scar. A diagonal design (dPAP) has since evolved to address some of the shortcomings of the tPAP. The authors aimed to compare outcomes of tPAP/dPAP flaps harvested for breast reconstruction by a single surgeon. Methods:. A retrospective review was conducted from 2017 to 2022 of patients undergoing tPAP versus dPAP-based breast reconstruction by a single surgeon at a tertiary cancer center. Patient variables and operative variables were assessed. Need for additional symmetrizing breast procedures were compared. Complications and BREAST-Q patient-reported outcome measures were analyzed. Results:. Thirty-nine flaps were used to reconstruct 35 breasts in 24 patients. Average follow-up for the group was 1.8 years. The groups were similar with respect to demographics. The majority of dPAP flaps had two perforators, whereas most tPAP flaps had one perforator. The dPAP flaps had greater average weights, width, and overall surface area. There were no cases of partial/total flap loss. Complications and PROM results were similar between the two groups. Conclusions:. The dPAP design allows for a larger skin paddle and greater tissue harvest and capture of cutaneous perforators, without increasing the risk of complications or compromising satisfaction. It should be considered as a viable option in patients unable to undergo abdominal-based reconstruction. Additional patients and multi-institutional efforts are necessary to better compare advantages of either design.

Published
2023
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21. D33. Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes

Author

Ethan L. Plotsker, BA, Carrie S. Stern, MD, Francis D. Graziano, MD, Robyn N. Rubenstein, MD, Perri S. Vingan, BS, Kathryn Haglich, MS, Jasmine Monge, BS, Joseph J. Disa, MD, Babak J. Mehrara, MD, Joseph H. Dayan, MD, Robert Allen, Jr., MD, Evan Matros, MD, MPH, MMSc, Colleen McCarthy, MD, and Jonas A. Nelson, MD, MPH

Subjects
Surgery, RD1-811
Published
2023
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26. Long-term Growth, Functional, and Aesthetic Outcomes after Fibula Free Flap Reconstruction for Mandibulectomy Performed in Children

Author

Farooq Shahzad, MBBS, MS, FACS, FAAP, Peter W. Henderson, MD, MBA, FACS, Evan Matros, MD, MMSc, FACS, and Peter G. Cordeiro, MD, FACS

Subjects
Surgery, RD1-811
Abstract

Background:. The long-term outcome of mandible reconstruction when performed in children has not been well documented. Methods:. This is a retrospective case series of patients who underwent immediate oncologic mandible reconstruction with a fibula free flap at younger than 18 years of age over a 20-year period, by a single surgeon, who had long-term follow-up. Results:. A total of 10 patients met inclusion criteria. Patient age ranged from 3 years and 8 months to 17 years and 9 months (mean 11 years). The etiology was malignant tumors in seven patients and benign locally aggressive tumors in three patients. All fibula flaps survived. All donor sites were closed primarily. The mean follow-up duration was 10 years and 5 months (range 3–20 years). The mean patient age at follow-up was 21 years and 10 months (range 8 years and 9 months to 30 years and 9 months). All patients achieved a regular diet and normal speech. Final occlusion was normal in seven of 10 patients. The aesthetic outcome, as evaluated by clinical examination, was a symmetric mandible in eight patients (in the other two the aesthetic asymmetry and malocclusion was minor and did not require operative intervention). Dental implants were ultimately placed in three patients. Leg function was normal in eight patients. Achilles lengthening and tendon transfer was required in one patient, and one patient developed ankle pain associated with running. Conclusion:. Mandible reconstruction in children with the fibula free flap provides excellent aesthetic and functional outcomes that are durable over time.

Published
2022
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34. Immediate Dental Implant Placement in the Oncologic Setting: A Conceptual Framework

Author

Rachel A. Anolik, MD, Jonas A. Nelson, MD, MPH, Evan B. Rosen, DMD, MPH, Joseph Disa, MD, Evan Matros, MD, MPH, and Robert J. Allen, Jr, MD

Subjects
Surgery, RD1-811
Abstract

Summary:. Historically, immediate dental implants have been reserved for patients with benign disease, with full dental rehabilitation rarely being accomplished in the oncologic setting due to concerns related to implant survival, flap compromise, and delay in initiation of adjuvant therapy. Recent developments in technology have made immediate dental implants using virtual surgical planning safe and reliable. At Memorial Sloan Kettering Cancer Center, we have implemented a workflow for immediate dental implant placement in the oncologic patient population that has become a routine part of maxillary and mandibular reconstruction. This approach begins with a multidisciplinary virtual surgical planning session and custom dental splints to be used for cutting and inset guides. Dental implants are placed intraoperatively at the time of tumor resection and reconstruction with the fibula flap. A temporary prosthesis, which can be worn during radiation therapy, is placed following a vestibuloplasty, approximately 4–6 weeks after the initial reconstruction. After the completion of radiation therapy and the resolution of edema, a permanent prosthesis is placed. When critically evaluating our experience, we have found that patients undergoing immediate dental implant placement have higher rates of implant survival and no delay in adjuvant therapy. The protocol described here in detail has successfully expanded the indications for immediate dental rehabilitation in the oncologic patient population.

Published
2021
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35. Virtual Surgical Planning for Oncologic Mandibular and Maxillary Reconstruction

Author

Paige L. Myers, MD, Jonas A. Nelson, MD, Evan B. Rosen, DDS, Robert J. Allen, Jr, MD, Joseph J. Disa, MD, and Evan Matros, MD, MPH, MMSc

Subjects
Surgery, RD1-811
Abstract

Summary:. Virtual surgical planning (VSP) with computer-aided design and computer-aided modeling (CAD/CAM) enables the opportunity to provide personalized medicine in complex head and neck reconstruction. This innovative technology allows ablative and reconstructive surgeons to virtually create and manipulate three-dimensional anatomic models to plan both the resection and reconstruction of complicated maxillofacial defects. Studies demonstrate improvements in preoperative planning, operative efficiency and accuracy, and postoperative outcomes. VSP facilitates immediate dental implantation in selected patients, which can improve the likelihood of achieving dental restoration. This article outlines strategies for technique optimization as well as the applications, advantages and disadvantages of VSP in complex oncologic head and neck reconstruction.

Published
2021
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39. P43. ACELLULAR DERMAL MATRIX AND PREPECTORAL TWO-STAGE BREAST RECONSTRUCTION: A COHORT ANALYSIS OF ALLODERM, FLEXHD AND SURGIMEND

Author

Jacqueline J. Chu, BA, Kathryn Haglich, MS, Robyn Rubenstein, MD, Cayla McKernan, MS, PA-C, Tajah Bell, MS, Richard T. Poulton, BS, Carrie S. Stern, MD, Joseph J. Disa, MD, Michelle R. Coriddi, MD, Joseph H. Dayan, MD, Robert J. Allen, Jr., MD, Babak J. Mehrara, MD, Evan Matros, MD, MPH, MMSc, and Jonas A. Nelson, MD, MPH

Subjects
Surgery, RD1-811
Published
2022
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44. 117. Textured Versus Smooth Tissue Expanders - A Comparison of Complications in 3526 Breast Reconstructions

Author

Robyn Nicole Rubenstein, MD, Evan Matros, MD, MMSc, MPH, Joshua Vorstenbosch, MD, PhD, Kathryn Haglich, BS, MS, Jacqueline J. Chu, BA, Cayla McKernan, MS, PA-C, Tajah Bell, BS, Richard T. Poulton, BS, De’von McGriff, MBA, MHA, Carrie S. Stern, MD, Michelle Coriddi, MD, Peter G. Cordeiro, MD, Colleen M. McCarthy, MD, MS, Joseph J. Disa, MD, Babak J. Mehrara, MD, and Jonas A. Nelson, MD, MPH

Subjects
Surgery, RD1-811
Published
2022
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45. QS7. Acellular Dermal Matrix and Prepectoral Two-stage Breast Reconstruction: A Cohort Analysis of Alloderm, FlexHD and SurgiMend

Author

Jacqueline J. Chu, BA, Kathryn Haglich, MS, Robyn Rubenstein, MD, Cayla McKernan, MS, PA-C, Tajah Bell, MS, Richard T. Poulton, BS, Carrie S. Stern, MD, Joseph J. Disa, MD, Michelle Coriddi, MD, Joseph Dayan, MD, Robert J. Allen, Jr., MD, Babak J. Mehrara, MD, Evan Matros, MD, and Jonas A. Nelson, MD

Subjects
Surgery, RD1-811
Published
2022
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46. Textured and Smooth Implant Use Reported in the Tracking Operations and Outcomes for Plastic Surgeons Database: Epidemiologic Implications for BIA-ALCL

Author

Evan Matros, MD, MMSc, MPH, Meghana G. Shamsunder, MPH, Robyn N. Rubenstein, MD, Thais O. Polanco, MD, Colleen M. McCarthy, MD, MS, Jonas A. Nelson, MD, MPH, Karol Gutowski, MD, and The TOPS Steering Committee

Subjects
Surgery, RD1-811
Abstract

Background:. Breast-implant–associated anaplastic large cell lymphoma (BIA-ALCL) is associated with prolonged exposure to textured implants. Current studies describing textured implant use are limited to single center/surgeon experiences. Using the Tracking Operations and Outcomes for Plastic Surgeons database, the study aims to characterize national trends in rates of smooth versus textured implant utilization. The hypothesis is that rates of textured implant use have decreased in the most recent time period. Methods:. Tracking Operations and Outcomes for Plastic Surgeons was queried from 2007 to 2019 for CPT codes involving breast implant use in augmentation and reconstruction. The rate of smooth and textured implant utilization was calculated for each year per procedure type. Generalized additive models with a smoothing function and Pearson chi-square tests were used to assess the trends. Results:. Textured implant use peaked in 2016, being utilized in 17.83% of cosmetic and 40.88% of reconstructive procedures. Textured implants were more commonly used for reconstructive compared with cosmetic cases for 2007–2009, 2011, and 2013–2019 (P < 0.02). Both cosmetic and reconstructive cases had nonlinear trends in textured implant use over the study period, with textured rates decreasing from 2017 to 2019 (P < 0.001). In 2019, textured implants were used in 2.15% of cosmetic and 7.58% of reconstructive cases. Conclusions:. This is the first national study describing trends in textured versus smooth breast implant use in the United States. Textured implant utilization peaked in 2016. Based on a median time horizon of 10 years before development of BIA-ALCL, the peak number of cases can be anticipated in 2026 or thereafter.

Published
2021
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49. P39. TEXTURED VERSUS SMOOTH TISSUE EXPANDERS - A COMPARISON OF COMPLICATIONS IN 3526 BREAST RECONSTRUCTIONS

Author

Jonas A. Nelson, MD, MPH, Robyn N. Rubenstein, MD, Joshua Vorstenbosch, MD, PhD, Kathryn Haglich, BS, MS, Jacqueline J. Chu, BA, Cayla McKernan, MS, PA-C, Tajah Bell, BS, Richard T. Poulton, BS, De’von McGriff, BS, Carrie S. Stern, MD, Michelle Coriddi, MD, Peter G. Cordeiro, MD, Colleen M. McCarthy, MD, MS, Joseph J. Disa, MD, Babak Mehrara, MD, and Evan Matros, MD, MMSc., MPH

Subjects
Surgery, RD1-811
Published
2022
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50. P46. COMPLICATIONS IN PREPECTORAL TISSUE EXPANDER PLACEMENT: A SINGLE INSTITUTION STUDY

Author

Jonas A. Nelson, MD, MPH, Robyn N. Rubenstein, MD, Ethan L. Plotsker, BA, Kathryn Haglich, BS, Jacqueline J. Chu, BA, Cayla McKernan, MS, PA-C, Tajah Bell, BS, Richard T. Poulton, BS, De’von McGriff, BS, Carrie S. Stern, MD, Michelle Coriddi, MD, Peter G. Cordeiro, MD, Colleen M. McCarthy, MD, MS, Joseph J. Disa, MD, Babak J. Mehrara, MD, and Evan Matros, MD, MMSc, MPH

Subjects
Surgery, RD1-811
Published
2022
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