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1. Imaging in Autologous Breast Reconstruction

Author

Janet C. Coleman-Belin, Joshua Barnett, Nima Khavanin, Jonas A. Nelson, Carrie S. Stern, and Robert J. Allen

Subjects
breast neoplasms, breast reconstruction, autologous, microsurgery, deep inferior epigastric flap perforator, surgical flaps, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

The evolution of imaging actively shapes clinical management in the field. Ultrasonography (US), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) stand out as the most extensively researched imaging modalities for ABR. Ongoing advancements include “real-time” angiography and three-dimensional (3D) surface imaging, and future prospects incorporate augmented or virtual reality (AR/VR) and artificial intelligence (AI). These technologies may further enhance perioperative efficiency, reduce donor-site morbidity, and improve surgical outcomes in ABR.

Published
2024
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12. 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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22. 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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25. Machine learning to predict individual patient-reported outcomes at 2-year follow-up for women undergoing cancer-related mastectomy and breast reconstruction (INSPiRED-001)

Author

André Pfob, Babak J. Mehrara, Jonas A. Nelson, Edwin G. Wilkins, Andrea L. Pusic, and Chris Sidey-Gibbons

Subjects
Decision-making, Breast reconstruction, Machine learning, Individualized treatment, Breast surgery, INSPiRED, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background: Women undergoing cancer-related mastectomy and reconstruction are facing multiple treatment choices where post-surgical satisfaction with breasts is a key outcome. We developed and validated machine learning algorithms to predict patient-reported satisfaction with breasts at 2-year follow-up to better inform the decision-making process for women with breast cancer. Methods: We trained, tested, and validated three machine learning algorithms (logistic regression (LR) with elastic net penalty, Extreme Gradient Boosting (XGBoost) tree, and neural network) to predict clinically important differences in satisfaction with breasts at 2-year follow-up using the validated BREAST-Q. We used data from 1553 women undergoing cancer-related mastectomy and reconstruction who were followed-up for two years at eleven study sites in North America from 2011 to 2016. 10-fold cross-validation was used to train and test the algorithms on data from 10 of the 11 sites which were further validated using the additional site's data. Area-under-the-receiver-operating-characteristics-curve (AUC) was the primary outcome measure. Results: Of 1553 women, 702 (45.2%) experienced an improved satisfaction with breasts and 422 (27.2%) a decreased satisfaction. In the validation set (n = 221), the algorithms showed equally high performance to predict improved or decreased satisfaction with breasts (all P > 0.05): For improved satisfaction AUCs were 0.86–0.87 and for decreased satisfaction AUCs were 0.84–0.85. Conclusion: Long-term, individual patient-reported outcomes for women undergoing mastectomy and breast reconstruction can be accurately predicted using machine learning algorithms. Our algorithms may be used to better inform clinical treatment decisions for these patients by providing accurate estimates of expected quality of life.

Published
2021
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34. Propensity Scoring in Plastic Surgery Research: An Analysis and Best Practice Guide

Author

Jacqueline J. Chu, BA, Meghana G. Shamsunder, MPH, Shen Yin, PhD, Robyn R. Rubenstein, MD, Hanna Slutsky, BS, John P. Fischer, MD, MPH, and Jonas A. Nelson, MD, MPH

Subjects
Surgery, RD1-811
Abstract

Summary:. Randomized controlled trials, though considered the gold standard in clinical research, are often not feasible in plastic surgery research. Instead, researchers rely heavily on observational studies, leading to potential issues with confounding and selection bias. Propensity scoring—a statistical technique that estimates a patient’s likelihood of having received the exposure of interest—can improve the comparability of study groups by either guiding the selection of study participants or generating a covariate that can be adjusted for in multivariate analyses. In this study, we conducted a comprehensive review of research articles published in three major plastic surgery journals (Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive, & Aesthetic Surgery, and Annals of Plastic Surgery) to determine the utilization of propensity scoring methods in plastic surgery research from August 2018 to August 2020. We found that propensity scoring was used in only eight (0.8%) of 971 research articles, none of which fully reported all components of their propensity scoring methodology. We provide a brief overview of propensity score techniques and recommend guidelines for accurate reporting of propensity scoring methods for plastic surgery research. Improved understanding of propensity scoring may encourage plastic surgery researchers to incorporate the method in their own work and improve plastic surgeons’ ability to understand and analyze future research studies that utilize propensity score methods.

Published
2022
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38. 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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41. 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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42. 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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46. 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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47. 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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48. 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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49. 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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