KCNY Plastic Surgery http://www.kcnyplasticsurgery.com Our mission is to provide aesthetic and reconstructive plastic surgical services that enrich and enhance the lives of our patients Sun, 29 Apr 2012 18:23:58 +0000 en hourly 1 http://wordpress.org/?v=3.1.3 Drs Karp and Choi Present Multiple Papers at American Association of Plastic Surgery Meeting in San Francisco 4/13-4/16/12 http://www.kcnyplasticsurgery.com/news/drs-karp-and-choi-present-multiple-papers-at-american-association-of-plastic-surgery-meeting-in-san-francisco-413-41612 http://www.kcnyplasticsurgery.com/news/drs-karp-and-choi-present-multiple-papers-at-american-association-of-plastic-surgery-meeting-in-san-francisco-413-41612#comments Sun, 29 Apr 2012 18:23:58 +0000 editor http://www.kcnyplasticsurgery.com/?p=839

...read more]]> Use of the Biopatch Drain Dressing to Reduce Infection Rates in Expander/Implant-Based Breast Reconstruction
Keith M. Blechman, MD, Patrick L. Reavey, MD, Katie Weichman, MD, Stelios Wilson, BA, Jamie P. Levine, MD, Mihye Choi, MD, Nolan S. Karp, MD.
New York University School of Medicine, New York, NY, USA.
Background: Infection rates for implant-based breast reconstructions are as high as 25%. Surgical drains may potentiate these complications by providing a route of entry for skin flora. To counteract this, we have recently begun covering drains with the Biopatch (Ethicon, Somerville, NJ), a dressing composed of a sterile foam disk impregnated with the antiseptic chlorhexidine gluconate. Randomized, controlled trials have demonstrated that the Biopatch reduces intravenous catheter-related bloodstream infections, but no data is published regarding its use with periprosthetic drains.
Methods: An IRB-approved, retrospective review of immediate breast reconstructions with either tissue expanders or implants performed at New York University Langone Medical Center from January to October 2011 was conducted. Patients were divided into two groups: (1) those who received the Biopatch drain dressing and (2) controls who did not. Office and hospital charts of all patients were reviewed. Infection rates, including minor infections treated with oral antibiotics, and major infections treated with intravenous antibiotics and explantation, were compared between groups using univariate analysis.
Results: A total of 170 consecutive breasts were included: 60 in the Biopatch group and 110 in the control group. Patients had similar preoperative and intraoperative characteristics. A threefold decrease in the overall infection rate was seen in the Biopatch group versus the control group (3% vs. 10%, p=0.14). Interestingly, in the subgroup of patients that had an inferolateral sling placed with either AlloDerm or SeriScaffold, a dramatic reduction in the infection rate was noted (0% in the Biopatch group vs 21% in the control, p=0.047).
Conclusions: Although limited by its design, this study provides the first reported data suggesting that use of the Biopatch as a drain dressing reduces infection rates in implant-based breast reconstruction. Given its low cost (less than \ per disk) and ease of use, the Biopatch is an important adjunct to potentially prevent infectious complications in these patients. We are currently performing a randomized, controlled trial at our institution to fully evaluate its effectiveness.

Limited use of Acellular Dermal Matrix Directly Correlates with Decreased Rates of Perioperative Infectious Complications in Immediate Implant Based Breast Reconstruction: A Single Institutional Experience
Katie Weichman, MD, Stelios Wilson, BS, Alexes Hazen, MD, Jamie Levine, MD, Mihye Choi, MD, Nolan Karp, MD.
New York University, New York, NY, USA.
PURPOSE:
A recent institutional retrospective review of immediate implant based breast reconstructions revealed increases in all major postoperative complications including major infection, mastectomy skin flap necrosis, and explantation associated with the use of Acellular dermal matrix (ADM). As a result of this investigation, strict guidelines were developed at our institution as a Quality Improvement Initiative. Indications for use included clear need of additional soft tissue support, inadequate inferior pectoralis muscle, and immediate permanent implant reconstruction. This study was conducted to assess the effects of these guidelines on patient outcomes and use of ADM.
METHODS:
After obtaining IRB approval and instituting guidelines, 264 consecutive immediate implant based breast reconstructions at a single institution over a 1-year period were prospectively gathered. The reconstructions were divided into two cohorts: those having reconstruction with ADM and those having reconstruction without ADM. The demographic information, preoperative breast size, use of methylene blue dye, need for lymph node dissection, breast cancer stage, use of adjuvant/neo-adjuvant chemotherapy and radiation, history of recent and remote breast surgery, surface area of ADM, and complications were analyzed and compared. This data was then compared to the previous retrospective review of 747 consecutive immediate implant based breast reconstructions in the three-year period prior to institution of guidelines looking at the same variables.
RESULTS:
: A total of 264 reconstructions were performed, 94% traditional two-stage tissue expander reconstructions and 6% one-stage immediate implants. The use of ADM decreased from 74.7% to 29.6% and reconstruction without ADM subsequently rose from 25.3% to 70.4%. The ADM and non-ADM cohorts had similar characteristics when compared: including mean age, mean BMI, percentage of small and large breasted women, cancer stage, medical co-morbidities, and smoking history. Overall infection rates fell from 11.1% to 7.1% (p<0.05) and major infection fell from 6.7% to 3.1% (p<0.05). Explantation also fell from 6.4% to 2.3% (p<0.05). Mastectomy skin flap necrosis was stable in both cohorts at 8.5% prior to guidelines and 9.9% (p=.255) after the implementation of guidelines. Breast undergoing reconstruction with ADM continued to have higher rates of mastectomy skin flap necrosis (12.8% vs 8.1% p<0.05), major infection 8.9% vs 0.5% p <0.05), and explantation (6.4% vs 0.5% p <0.05) when compared to those without ADM. Rates of overall infection, mastectomy skin flap necrosis, and explantation were similar when comparing ADM cohorts pre and post guidelines respectively (14.6% vs 12.8%, 10.4% vs 12.8%, and 7.5% vs 6.4%).
CONCLUSION:
Placing limitations on the use of ADM in immediate implant based breast reconstruction resulted in decreased major postoperative infectious complications. ADM, however, continued to render an increased risk of major complications when compared to reconstructions without ADM. This may be attributable to the fact that ADM is used in more demanding cases such as in large breast reconstruction, lack of muscle coverage, and nipple sparing mastectomy. We advise using ADM in select cases with clear indications.

Antibiotic Selection in the Treatment of Infectious Complications of Immediate Implant Based Breast Reconstruction
Katie Weichman, MD, Steve Levine, MD, Stelios Wilson, BS, Mihye Choi, MD, Nolan Karp, MD.
New York University, New York, NY, USA.
Purpose: Infection requiring explantation remains the most dreaded and devastating complication associated with implant-based breast reconstruction. There are many treatment algorithms to prevent reconstructive failure in the face of infection utilizing both oral and intravenous antibiotics. In the absence of patient specific culture data, antibiotic selection is generally directed towards broad-spectrum coverage based on historical data. We hypothesize that reviewing our institutions microbiology data obtained from explanted implant-based breast reconstructions would provide a rational basis for antibiotic selection in the future.
Methods: A retrospective review of 902 consecutive immediate implant based breast reconstructions at a single institution from November 2007 to May 2011 was conducted. Implants requiring explantation and interventional radiology drainage were identified. Patient demographics, implant characteristics, use of ADM, presence of skin necrosis, microbiological data, and outcomes were reviewed for analysis.
Results: Fifty-four (5.98%) implants requiring explantation and two (0.5%) reconstructions requiring radiologic guided drainage were identified. A total of forty-three implants were included for analysis because thirteen implants lacked culture data. Eight permanent round smooth silicone implants and thirty-five round textured tissue expanders were explanted with average size 637mL and 430mL respectively. Twenty-six implants were explanted due to infection, three due to exposure from skin necrosis, eleven due to combination of flap necrosis and infection, and one implant was removed for cancer invasion. Reconstruction was salvaged in twenty-eight breasts (56.0%); thirteen with implant reconstruction; five with pedicled latissimus dorsi flap and ten breasts went on to microvascular free flap reconstruction. Thirty explants had microbiology data available. The most common organism isolated was staphylococcus epiderminis (10), followed by serratia marcescens (5), staphylococcus aureus (5), pseudomonas aeruginosa (4), enterococcus (3), enterobactr (2), ecoli (2) and MRSA (1). 56% of reconstructions received pre-culture Vancomycin. 40% of organisms were resistant to Cefazolin, however, 86% were sensitive to Gentamycin, 80% sensitive to Levaquin and 63% to Ciprofloxacin.
Conclusions: Infections associated with implant-based breast reconstructions continues to threaten explantation and reconstructive failure. Based on our microbiologic data, initial cellulitis amenable to oral antibiotics should be treated with oral fluoroquinolones as a first line treatment. If this regiment fails, intravenous Gentamycin or Imipenem and Vancomycin should be initiated. Obviously, clinical judgment regarding specific patient risk factors and compliance plays a role in decision-making, but this data provides an evidence-based rational for first line antibiotic selection

]]> http://www.kcnyplasticsurgery.com/news/drs-karp-and-choi-present-multiple-papers-at-american-association-of-plastic-surgery-meeting-in-san-francisco-413-41612/feed 0 Breast Reconstruction: State of the Art Brochure http://www.kcnyplasticsurgery.com/news/breast-reconstruction-state-of-the-art-brochure http://www.kcnyplasticsurgery.com/news/breast-reconstruction-state-of-the-art-brochure#comments Fri, 27 Jan 2012 00:59:23 +0000 editor http://www.kcnyplasticsurgery.com/?p=831 Click on link below to view the brochure for this course

NYUP1107brochure_7-25-11changes

]]> http://www.kcnyplasticsurgery.com/news/breast-reconstruction-state-of-the-art-brochure/feed 0 Drs Karp and Choi host National Conference “Breast Reconstruction: State of the Art” http://www.kcnyplasticsurgery.com/news/drs-karp-and-choi-host-national-conference-breast-reconstruction-state-of-the-art http://www.kcnyplasticsurgery.com/news/drs-karp-and-choi-host-national-conference-breast-reconstruction-state-of-the-art#comments Fri, 27 Jan 2012 00:50:53 +0000 editor http://www.kcnyplasticsurgery.com/?p=817 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.

]]> http://www.kcnyplasticsurgery.com/news/drs-karp-and-choi-host-national-conference-breast-reconstruction-state-of-the-art/feed 0 Drs Karp and Choi write article on Nipple-sparing mastectomy and reconstruction through lateral scar http://www.kcnyplasticsurgery.com/breast-reconstruction/drs-karp-and-choi-write-article-on-nipple-sparing-mastectomy-and-reconstruction-through-lateral-scar http://www.kcnyplasticsurgery.com/breast-reconstruction/drs-karp-and-choi-write-article-on-nipple-sparing-mastectomy-and-reconstruction-through-lateral-scar#comments Mon, 05 Sep 2011 23:32:06 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=89

...read more]]> 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
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]]> http://www.kcnyplasticsurgery.com/breast-reconstruction/drs-karp-and-choi-write-article-on-nipple-sparing-mastectomy-and-reconstruction-through-lateral-scar/feed 0 Nice comment from nipple sparing mastectomy patient http://www.kcnyplasticsurgery.com/breast-reconstruction/nice-comment-from-nipple-sparing-mastectomy-patient http://www.kcnyplasticsurgery.com/breast-reconstruction/nice-comment-from-nipple-sparing-mastectomy-patient#comments Tue, 16 Aug 2011 00:06:52 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=86

...read more]]> Reflections one year later, ” I will remember when”…

Postby 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
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]]> http://www.kcnyplasticsurgery.com/breast-reconstruction/nice-comment-from-nipple-sparing-mastectomy-patient/feed 0 Zeltiq/Coolsculpting Now Offered by Drs Karp and Choi http://www.kcnyplasticsurgery.com/body-contouring/zeltiqcoolsculpting-now-offered-by-drs-karp-and-choi http://www.kcnyplasticsurgery.com/body-contouring/zeltiqcoolsculpting-now-offered-by-drs-karp-and-choi#comments Sun, 26 Sep 2010 01:20:56 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=83

...read more]]> 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.

]]> http://www.kcnyplasticsurgery.com/body-contouring/zeltiqcoolsculpting-now-offered-by-drs-karp-and-choi/feed 0 Dr. Karp featured in article on Nipple-Sparing Mastectomy with Reconstruction http://www.kcnyplasticsurgery.com/breast-reconstruction/dr-karp-featured-in-article-on-nipple-sparing-mastectomy-with-reconstruction http://www.kcnyplasticsurgery.com/breast-reconstruction/dr-karp-featured-in-article-on-nipple-sparing-mastectomy-with-reconstruction#comments Mon, 16 Aug 2010 23:05:22 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=81 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

]]> http://www.kcnyplasticsurgery.com/breast-reconstruction/dr-karp-featured-in-article-on-nipple-sparing-mastectomy-with-reconstruction/feed 0 Nice Comment from a patient having Nipple-Sparing mastectomy http://www.kcnyplasticsurgery.com/breast-reconstruction/nice-comment-from-a-patient-having-nipple-sparing-mastectomy http://www.kcnyplasticsurgery.com/breast-reconstruction/nice-comment-from-a-patient-having-nipple-sparing-mastectomy#comments Fri, 13 Aug 2010 12:47:27 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=79

...read more]]> 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!!

]]> http://www.kcnyplasticsurgery.com/breast-reconstruction/nice-comment-from-a-patient-having-nipple-sparing-mastectomy/feed 1 Dr Karp Named to New York Magazine’s Best Doctor list http://www.kcnyplasticsurgery.com/news/dr-karp-named-to-new-york-magazines-best-doctor-list http://www.kcnyplasticsurgery.com/news/dr-karp-named-to-new-york-magazines-best-doctor-list#comments Mon, 14 Jun 2010 21:54:42 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=77 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/

]]> http://www.kcnyplasticsurgery.com/news/dr-karp-named-to-new-york-magazines-best-doctor-list/feed 0 Drs Karp and Choi present at Plastic Surgery Research Council http://www.kcnyplasticsurgery.com/breast-reduction/drs-karp-and-choi-present-at-plastic-surgery-research-council http://www.kcnyplasticsurgery.com/breast-reduction/drs-karp-and-choi-present-at-plastic-surgery-research-council#comments Wed, 09 Jun 2010 01:24:33 +0000 kcny http://www.kcnyplasticsurgery.com/blog/?p=75

...read more]]> 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.

]]> http://www.kcnyplasticsurgery.com/breast-reduction/drs-karp-and-choi-present-at-plastic-surgery-research-council/feed 4