Breast Reconstruction: State of the Art Brochure

January 27th, 2012

Click on link below to view the brochure for this course

Drs Karp and Choi host National Conference “Breast Reconstruction: State of the Art”

January 27th, 2012

On November 18 & 19, 2011 Drs Karp and Choi hosted “Breast Reconstruction: State of the Art” at NYU Langone Medical Center. This course covered the entire range of breast reconstruction surgery after mastectomy. This included Nipple-Sparing mastectomy, autologous reconstruction, and implant based breast reconstruction.

Drs Karp and Choi write article on Nipple-sparing mastectomy and reconstruction through lateral scar

September 5th, 2011

The Lateral Inframammary Fold Incision for Nipple-Sparing Mastectomy: Outcomes from Over 50 Immediate Implant-Based Breast Reconstructions.

Keith M. Blechman, MD, Chaya Levovitz, BA, Amber A. Guth, MD, Deborah M. Axelrod, MD, Richard L. Shapiro, MD, Mihye Choi, MD, Nolan S. Karp, MD. New York University, New York, NY, USA.

BACKGROUND: Nipple-sparing mastectomy (NSM) is rapidly gaining popularity as its safety and efficacy continue to be supported. NSM decreases scar burden and leaves the nipple-areola complex (NAC) intact, affording superior aesthetics compared to traditional skin-sparing reconstructions. The lateral inframmammary fold (LIMF) incision provides adequate access and eliminates an anterior scar, making this incision cosmetically preferable to other approaches. Here we present our experience with NSM through a LIMF incision, with immediate implant-based reconstruction.

METHODS: We retrospectively reviewed 52 consecutive nipple-sparing mastectomies via a LIMF incision from June 2008 to April 2011 that underwent immediate implant-based reconstruction, with or without use of a tissue expander. Breasts were gently infiltrated with hemostatic anesthetic solution, and sharp dissection was preferred to avoid thermal injury to the mastectomy flap. Intraoperative subareolar biopsies were performed. Three-dimensional (3D) photographs were obtained prior to mastectomy and after reconstruction was complete. 3D parameters included volume, antero-posterior projection, and ptosis (defined by the distance from a set superior point to the inferior breast pole).

RESULTS: Average age was 47 years. Mean follow-up time was 11 months. Therapeutic mastectomy was performed in 23% of breasts, and prophylactically in 77%. Tissue expansion was used in 93%, and Alloderm was used in 65%. Fat grafting (average 92cc) was performed if residual contour deformities remained. If sentinel lymph node biopsy was performed, it was possible via the LIMF incision in 75%. Three nipples (6%) suffered partial necrosis. Two mastectomy flaps (4%) underwent operative debridement, one which required a salvage latissimus dorsi flap. There were no hematomas, seromas, or locoregional recurrences. 3D analysis demonstrated larger (196 vs 248cc), more projected (80 vs 90mm), and less ptotic breasts (146 vs 134mm) (p<0.01).

CONCLUSIONS: Excellent outcomes can be achieved following NSM through a LIMF incision using immediate expander/implant reconstruction. There is no anterior scar burden, and sentinel lymph node biopsy can be performed without a counter-incision. NAC and mastectomy flap survival rates are high. NSM reconstruction via this approach can create larger, more projected, and less ptotic breasts.

http://meeting.nesps.org/2011/69.cgi

LISAMG: extended_access; Posts: 3213; Joined: 2/20/2006, 10:21 am; Location: Somewhere over the rainbow…

Nice comment from nipple sparing mastectomy patient

August 15th, 2011

Reflections one year later, ” I will remember when”…

by LISAMG » 8/14/2011, 10:15 pm

…I had my first encounter with BC when my paternal grandma [aka grammie] died at the age 0f 52. I was 10 years old and the “C” word was like the forbidden “F” word, never spoken. My maternal grandmother had died when i was 5, but thats about all i remember of her.

…My mom’s sister developed BC during my late teenager years. She died a few years later. It was years following that i learned my paternal great gm died of OVCA in her mid forties, but i managed to conceal this and never thought much of it.

…Another aunt had BC too, but later died of other causes.

…I had my first surgical breast biopsy in 2005 to rule out Pagets Disease after unsuccessful treatment with a dermatologist. Thankfully, all was benign. This is when i first began to realize a hereditary/familial predisposition was a possibility.

…Exactly 4 months later, I found a lump in the same breast, but it too, was found to be benign.

…Four months passed and my younger cousin developed stage 2 BC at the age of 42.

…I found FORCE in February of 2006 as I was awaiting my genetic testing results. I tested negative for any BRCA mutation in March, but nobody had yet tested for a possible mutation in my family.

…During the summer of 2006, just 15 months after my first biopsy, i finally told my BS I wanted to remove my breasts. I was facing another surgical excision on the opposite breast for new onset bloody nipple discharge. Again, i dodged the bullet with hyperplasia and papilloma findings.

…My maternal aunt was diagnosed with stage 3C ovca just before the Christmas holiday, December 2007. She is also BRCA negative.

…I spent 4.5 years of trying to make a decision for myself, but stuck with surveillance until my tolerance wore me down ever so tirelessly.

…I had an atypical mole removed on my left chest above the breast one month prior to my NSM as per my surgical oncologist. All was OK. I also had a complex ovarian cyst that required repeat scans and blood work 2 months prior to my mastectomy date. I was on the verge of collapse, not knowing whether i would be having a PBM or a BSO. Thankfully, i was given the green light to proceed with MY choice.

…On the morning of August 10, 2010, I was given a new life, a new beginning with a sense of renewal, hope and empowerment. I received a priceless gift that was denied to both maternal/paternal grandmothers, aunts and cousins. Each one of these family members suffered from hereditary breast cancer. I refused to become another potential victim of this devastating familial disease.

As a result, I had a risk reducing bilateral total skin nipple/areola sparing mastectomy followed by immediate breast reconstruction. Not only does this “cutting edge” procedure allow many women a dramatic risk reduction, but it also provides us with a huge sense of normalcy and amazing outcomes, without compromising oncological safety. This is also in accordance with the latest research findings that continually demonstrate a broad acceptance and approval within the oncology community. It was the expertise, amazing skill, compassion and trust with my breast surgical oncologist [Richard Shapiro] that made this possible for myself. My PS [Nolan Karp] was equally impressive by fully restoring my breasts with such skillful artistry, leaving me with a natural appearance. Together they have formed a unique and highly skilled partnership. Many women whose lives have been touched by breast cancer, whether they are a “previvor” like myself or survivors, have this gentler option. I truly feel as though I have lost nothing, but my risks.

…Another cousin was diagnosed with advanced BC at the age of 53 just one month after my PBM. She continues to battle the disease without an identifiable BRCA mutation.

…Sadly, my aunt dies of ovca after a courageous 3.5 year battle in June of this year.

…August 10, 2011 arrives!! My first anniversary & many many more yet to come, my new birthday, i feel…fortunate and ever so blessed. Its been an amazing journey. I hope to always remain a previvor. For those who are also previvors, may we all previve together, forever and ever. And for those less fortunate, may you always be a survivor, true inspirations for all of us. Finally, for all of our loved ones who have died of hereditary cancers or any cancer…We will always remember you & shall never forget how much our lives were touched by your brief and powerful presence as we seek a cure to end the deadly curse once and for all.

LISAMG: extended_access; Posts: 3170; Joined: 2/20/2006, 10:21 am; Location: Somewhere over the rainbow…

Zeltiq/Coolsculpting Now Offered by Drs Karp and Choi

September 25th, 2010

Just two weeks ago Zeltiq (now called Coolsculpting) was approved by the FDA for non-invasive fat reduction. Drs Karp and Choi now offer this technology. Please call our office for a consultation. The procedure is done in hourly sessions, and there is no down time whatsoever. You can go to work and do everything immediately. For more information go to www.coolsculpting.com.

Dr. Karp featured in article on Nipple-Sparing Mastectomy with Reconstruction

August 16th, 2010

Article was published in the magazine News & Views of the NYU Langone Medical Center. To view article go to link:

http://newsandviews.med.nyu.edu/women-who-face-mastectomy-gentler-option

Nice Comment from a patient having Nipple-Sparing mastectomy

August 13th, 2010

First, I would like to extend my very deepest thanks and appreciation to my brother, Steve for the marvelous surprise visit while in the hospital yesterday. I would also like to thank all my wonderful FORCE sisters for the many uplifting phone calls and well wishes too. Just a minor correction, my surgery was on Tuesday, not Monday, and I’m now 48 hours post op. I feel well, but exhausted, despite difficulties with the initial pain management and some expected bruising. I have inframammary incisions and both nipples are remarkably pink. For those who know my story, I had some concerns with nipple viability, given my history of complications in the past. However, it was my full trust with my BS’s confidence/technique/expertise that allowed me to pursue nipple sparing risk reducing surgery. My amazing surgeons, Richard Shapiro and Nolan Karp, of NYU have been performing NSM for over a year now with fabulous outcomes. Together they have formed an incredibly skilled partnership. The pre/post op nursing care was outstanding as well. I am taking both Percocet and Valium [for muscle spasms and highly recommended] around the clock. My boobs [and they're certainly not "foobs" to me] seem very real. Honestly, I feel like I have lost nothing but my risks, but have new stuffing now!!! My relief was felt immediately in the recovery room when both of my surgeons came to my bedside told me to look down at my chest and see for myself…the feeling and emotions were truly beyond words of expression.

Lastly, I wish to offer some inspiring and positive thoughts to all my high risk sisters, especially to those who are un-informative BRCA negative,,,,know your strengths and weaknesses and allow all of them to provide you with the empowerment needed to make a fully informed decision. Take your time since there are no real limits and you will have no regrets….for myself this agonizing process took almost 5 years. Seek many opinions and know ALL your options. The decision making process is extremely painful and ever so agonizing, but you and only you can decide when/what is best for you. Don’t ever let anyone ever tell you different. Believe in yourself, do your homework & you will find the strength and determination to make a fully informed decision, whether it be surveillance or preventative surgery, both are viable and highly personal choices. Again, my thanks to all for helping me “reach the other side” where I finally belong and feel “home free” for the first time than I can ever remember….the feeling is simply awesome!!

Dr Karp Named to New York Magazine’s Best Doctor list

June 14th, 2010

Dr. Karp was listed in the New York Magazine Best Doctor’s list published June 14, 2010. To see the article go to: http://nymag.com/bestdoctors/

Drs Karp and Choi present at Plastic Surgery Research Council

June 8th, 2010

Drs Karp and Choi and their research team presented 3 papers at the Plastic Surgery Research Council in San Francisco May 25 & 26 2010. The papers all involved 3D imaging and studied fat grafting to the breast, long-term breast reduction surgery, and comparing short scar and traditional scar breast reduction surgery. The papers were well received and continue to demonstrate Drs Karp and Choi’s leadership role in 3D imaging of the breast.