Faculty Bibliography

BACKGROUND: Reduction mammaplasty has been shown to be efficacious in reducing the burden of symptoms and improving the quality of life for patients with macromastia. However, most insurance carriers will not reimburse for mammaplasties involving less than 1000 g of total tissue resected. To refute this arbitrary policy, the authors set out to examine the effect of reduction mammaplasty in which less than 1000 g of breast tissue was resected on patients' macromastia-related symptoms and macromastia-related quality-of-life factors. METHODS: All patients were given a custom-designed questionnaire designed to evaluate macromastia-related symptoms and other macromastia-related quality-of-life issues. Patients were then provided the same questionnaire at their final postoperative visit between 3 and 12 months after surgery. RESULTS: A total of 59 patients underwent reduction mammaplasty of less than 1000 g. Reduction mammaplasty less than 1000 g resulted in significant decreases in all macromastia-related symptoms analyzed, including upper back pain, lower back pain, neck pain, arm pain, shoulder pain, hand pain, breast pain, headaches, rashes, and/or itching and painful bra strap grooving (all p < 0.00002). Furthermore, reduction mammaplasty resulted in significant improvement in all quality-of-life factors analyzed, including difficulty buying clothes and bras, difficulty participating in sports, and difficulty running (all p < 0.00001). CONCLUSIONS: Reduction mammaplasty totaling less than 1000 g offers substantial relief of macromastia-associated symptoms and results in significant improvement in patients' quality of life. This prospective study conclusively demonstrates that reduction mammaplasty totaling less than 1000 g should be a fully reimbursable procedure

BACKGROUND: Lower-extremity reconstruction with microvascular free flap coverage is often the only option for limb salvage. Flap failure rates, however, continue to have higher complication rates than those to other anatomic sites; a significant number of flaps that fail result in amputation. This study retrospectively analyzed patients treated at a single institution who underwent attempted lower-extremity limb salvage with microsurgical techniques over a 25-year period. Of particular interest are the outcome data for patients who had initial free flap failure. PATIENTS AND METHODS: A prospectively maintained database was used to identify patients who satisfy criteria. Every patient who was treated with a microvascular free flap to their lower extremities was identified and included in this analysis. All records were reviewed from 1980 through 2004. Patients who had free flaps to the lower extremity fail after the initial operation were identified and selected for further analysis. RESULTS: Five hundred eighty-eight patients who underwent microsurgical reconstruction of lower extremity wounds had a failure rate of 8.5%. Trauma patients (83%) had a failure rate of 9%. On subset analysis, the failure rate for trauma patients decreased from 11% (1980-1992) to 3.7% (1993-2004). Of patients who had a failed free flap, 18% went on to limb amputation; the remainder was salvaged with secondary free flaps, local flaps, or skin grafting. CONCLUSION: This single institutional experience spanning 25 years represents the longest continual series of lower-extremity free flaps reported in the literature. The improved success rate seen in the second half of the study period is attributed to a more critical selection of free-flap candidates, improved understanding of the physiology surrounding acute trauma and a more sophisticated multidisciplinary team organization

In response to the global rise in obesity, bariatric surgery has become increasingly more popular and successful. As a result, the demand for body contouring following massive weight loss is rapidly growing. Although bariatric procedures may produce impressive weight loss, people who achieve massive weight loss are often unhappy with the hanging folds of skin and subcutaneous tissue that remain. This review examines the nature of the post-bariatric deformity in each body region and briefly reviews common approaches to their treatment

Three-dimensional (3D) imaging technology currently is used by various commercial industries as a method for analyzing objects and shapes. Recent work from our group and others offer data to support the use of 3D imaging as a valuable tool in aesthetic and reconstructive breast surgery. We have developed a system for creating 3D breast models that provides clinical data that can help guide surgical management. With 3D breast models, surgeons are able to visually assess the size, shape, contour, and symmetry of the breast, as well as obtain quantitative breast measurements and volumetric calculations. Three-dimensional imaging may be applied to various plastic surgery procedures including breast reconstruction with implant/tissue expanders, local flap reconstruction, free-flap reconstruction, breast augmentation, and breast reduction surgery. The novel application of 3D imaging in these settings represents a significant advance from traditional approaches to aesthetic and reconstructive breast surgery in which surgical procedures are based on 2-dimensional photographs and visual size estimates

BACKGROUND: In the United States, breast reductions based upon a Wise pattern incision remain common. However, dissatisfaction with this procedure, on the part of the patient and the surgeon alike because of unsightly scars and long-term 'bottoming out' of the breast, has promoted the search for alternative methods of breast reduction. The purpose of this study was to analyze patient outcomes after vertical reduction mammaplasty utilizing prospectively collected data. METHODS: All patients were given a custom-designed questionnaire designed to evaluate their macromastia-related symptoms and other macromastia-related quality-of-life issues. Patients were then provided the same questionnaire at their final postoperative visit between 3 and 6 months after surgery. RESULTS: A total of 63 patients underwent vertical reduction mammaplasty and 40 patients underwent Wise pattern inferior pedicle reduction mammaplasty. Vertical reduction mammaplasty resulted in significant decreases in all macromastia-related symptoms analyzed, including upper back pain, lower back pain, neck pain, arm pain, shoulder pain, hand pain, breast pain, headaches, rashes and/or itching, and painful brassiere strap grooving (all, p < 0.00001). Furthermore, vertical reduction mammaplasty resulted in significant improvement in all quality-of-life factors analyzed, including difficulty buying clothes and brassieres, difficulty playing sports, and difficulty running (all, p < 0.00001). Minor complications (superficial infection, seroma, or delayed wound healing) occurred in 16 patients (25 percent) in the vertical reduction mammaplasty group. Minor office revisions (scar revision or excision) were performed in four patients (6 percent) in the vertical reduction mammaplasty group. CONCLUSION: The authors' method of vertical reduction mammaplasty offers substantial relief of macromastia-associated symptoms with a low complication/revision rate

Excessively large breasts can be so painful that even the rare risk of losing her nipples and areolae won't dissuade a woman from undergoing reduction surgery. This article--by two plastic surgeons--gives you information on the pros and cons of various surgical approaches so you can educate patients about all of their options

Over the past several years, I noted an increased demand for shorter-scar breast reductions. I started to perform the vertical scar/medial pedicle breast reduction in January of 2001. Since that time, 120 procedures were performed, and these cases are the basis for this study. Over the time period of this study, there was a learning curve. I first started performing the procedure only on smaller reductions (<600 g each side) and now perform the short scar reduction for most patients having <1000 g removed from each side. The purpose of this study is to demonstrate the technical points required to make the transition to short-scar breast reduction easy and reliable

Vascular malformations can usually be diagnosed on clinical grounds. They have a well-defined appearance on magnetic resonance imaging, which can effectively determine their tissue and flow characteristics. However, the role of cross-sectional imaging in the management of vascular malformations is not well defined. Most reviews suggest that magnetic resonance imaging should be reserved for cases in which the extent of the lesion cannot be estimated on physical examination. However, to date no group has compared the accuracy of physical examination alone to that of magnetic resonance imaging in determining this extent. A review was performed of all the patients evaluated for vascular malformations at the New York University Trunk and Extremity Vascular Anomalies Conference between July of 1994 and August of 1999. Patients who underwent magnetic resonance evaluation at other institutions and whose images were not available for review were excluded. All study patients either underwent magnetic resonance imaging examination at New York University Medical Center or had outside films reviewed at the center. The physical examination findings were compared with the magnetic resonance findings and the surgeon and radiologist made a joint decision about whether there was a correlation between the magnetic resonance and physical examination findings. Fifty-eight patients met the study criteria, 44 (76 percent) of whom were found to have more extensive disease on magnetic resonance examination than appreciated on physical examination. Of the 51 patients with low-flow vascular malformations (venous vascular malformations, lymphatic malformations, and capillary malformations), 39 (76 percent) had more extensive disease on magnetic resonance examination than on physical examination. Of the seven patients with high-flow arteriovenous malformations, five had more extensive disease on magnetic resonance. In all of the 44 patients whose magnetic resonance imaging findings did not correlate with those of the physical examination, therapeutic decision making was affected. Contrary to the conventional wisdom of published reviews, physical examination findings significantly underestimated the extent of vascular malformations in the majority of cases. Magnetic resonance imaging should be performed in all patients with vascular malformations of the trunk and extremities before therapy is planned. In an age when physicians are asked to justify their decisions, especially where the use of expensive diagnostic modalities is concerned, the situations in which these tests are indispensable must be clearly defined or else patients will be denied access to them