Babak J Mehrara

Memorial Sloan-Kettering Cancer Center, New York City, New York, United States

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Publications (206)472.99 Total impact

  • Plastic and reconstructive surgery. 10/2014; 134(4S-1 Suppl):88.
  • Plastic and reconstructive surgery. 10/2014; 134(4S-1 Suppl):89.
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    ABSTRACT: Abstract Background: The lymphatic system is commonly injured during cancer treatment. However, despite the morbidity of these injuries, there are currently no options for replacing damaged lymphatics. The purpose of this study was to optimize methods for decellularization of murine lymph nodes (LN) and to determine if these scaffolds can be used to tissue engineer lymph node-like structures. Methods and Results: LNs were harvested from adult mice and subjected to various decellularization protocols. The degree of decellularization and removal of nuclear material was analyzed histologically and quantitatively using DNA isolation. In addition, we analyzed histological architecture by staining for matrix proteins. After the optimal method of decellularization was identified, decellularized constructs were implanted in the renal capsule of syngeneic or allogeneic recipient mice and analyzed for antigenicity. Finally, to determine if decellularized constructs could deliver lymphocytes to recipient animals, the matrices were repopulated with splenocytes, implanted in submuscular pockets, and harvested 14 days later. Decellularization was best accomplished with the detergent sodium dodecyl sulfate (SDS), resulting in negligible residual cellular material but maintenance of LN architecture. Implantation of decellularized LNs into syngeneic or allogeneic mice did not elicit a significant antigenic response. In addition, repopulation of decellularized LNs with splenocytes resulted in successful in vivo cellular delivery. Conclusions: We show, for the first time, that LNs can be successfully decellularized and that these matrices have preserved extracellular matrix architecture and the potential to deliver leukocytes in vivo. Future studies are needed to determine if tissue engineered lymph nodes maintain immunologic function.
    Lymphatic Research and Biology 08/2014; · 2.33 Impact Factor
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    ABSTRACT: Lymphedema is a chronic debilitating condition and curative treatment is yet to be found. Tissue engineering approach, which combines cellular components, scaffold, and molecular signals hold great potential in the treatment of secondary lymphedema with the advent of lymphatic graft to reconstruct damaged collecting lymphatic vessel. This review highlights the ideal characteristics of lymphatic graft, the limitation and challenges faced, and the approaches in developing tissue-engineered lymphatic graft.
    Journal of Surgical Research 07/2014; · 2.02 Impact Factor
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    ABSTRACT: Lymphödem ist eine häufige Erkrankung, bei der das Lymph­ system nicht in der Lage ist, interstitielle Flüssigkeit adäquat zu beseitigen. Dabei handelt es sich um eine chronische und progressive Krankheit, die mit einer Akkumulation von Flüssigkeit beginnt, im Laufe der Zeit verändert sich die Pathologie aber zu einer Anreicherung von adipofibrotischem Gewebe. Die Einla­ gerung von Fettgewebe ist ein histologischer und patho­ logischer Schlüsselprozess beim chronischen Lymph­ ödem. Obwohl dieser Prozess dazu führt, dass das Lymphödem auf herkömmliche Behandlungsmethoden wie Manuelle Lymphdrainage und Kompressionsbe­ strumpfung nicht mehr reagiert, ist wenig darüber bekannt, wie die Fetteinlagerung in das Lymphödem reguliert wird. Unsere Forschungsgruppe konnte kürzlich zeigen, dass eine lymphatische Verletzung zu einer Aktivierung von Fettdifferenzierungsgenen führt, was in einer Hypertro­ phie und Proliferation von Adipozyten resultiert (1, 2). Genau genommen haben wir herausgefunden, dass das in einem Lymphödem eingelagerte Fettgewebe histolo­ gisch ähnlich ist zu demjenigen bei einer generalisierten Fettleibigkeit, was durch eine Infiltration chronisch inflammatorischer Zellen sichtbar ist (3, 4). Diese Erkenntnisse deuten darauf hin, dass Adipozyten und der Prozess der Fetteinlagerung eine Rolle in der Pathologie des Lymphödems spielen können. Dieses Konzept wird von der Tatsache unterstützt, dass eine Fetteinlagerung ein Schlüsselregulator einer Vielzahl von Erkrankungs­ prozessen ist. Ein Mechanismus, bei dem das Fettgewebe eine Patholo­ gie moduliert, ist die Entstehung von Wachstumsfaktoren und Zytokinen wie Interleukin­6 (IL­6). In der laufenden Studie haben wir beschlossen, uns auf IL­6 zu fokussie­ ren, weil frühere Studien gezeigt haben, dass die Expres­ sion von IL­6 signifikant erhöht ist bei beiden Tiermo­ dellen für primäre und sekundäre Lymphödeme. Auch ist IL­6 dafür bekannt, bei der Fettgewebe­Homöostase eine kritische Rolle zu spielen (5, 6). Was noch ausführlich beschrieben werden muss ist, wel­ cher Verbindungsmechanismus zwischen Entzündung und Fetthomöostase beim Lymph ödem zugrunde liegt. In dieser Studie möchten wir die Rolle von IL­6 bei der Fetteinla­ gerung im Lymphödem untersu­ chen. Wir fanden heraus, dass klinische Biopsieproben und Serum von Lymphödempatien­ ten signifikant erhöhte IL­6­Werte ebenso im Serum wie auch im ödematösen Gewebe aufwiesen. Diese Expres­ sion von IL­6 war stark assoziiert mit der Fetteinlagerung und Entzündung in unserem Maus­Lymphödem­Modell. Interessanterweise scheint die CD4 +
    Vasomed 07/2014; 26(3):146-149.
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    ABSTRACT: The aim of this study was to determine whether sterile inflammatory reactions can serve as a physiologic means of augmenting lymphangiogenesis in transplanted lymph nodes using a murine model.
    Plastic and reconstructive surgery. 07/2014; 134(1):60-68.
  • Babak J Mehrara, Arin K Greene
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    ABSTRACT: Lymphedema is a chronic disorder that, in developed countries, occurs most commonly after lymph node dissection for cancer treatment. Although the pathophysiology of lymphedema is unknown, the disease is characterized histologically by fibrosis and abnormal adipose deposition. Clinical studies have provided evidence that obesity and postoperative weight gain are significant risk factors for the development of lymphedema. In fact, recent studies have shown that extreme obesity can result in markedly impaired lymphatic function and primary lymphedema. The aim of this Special Topic article is to review evidence linking obesity and lymphedema. In addition, the authors review recent studies that have analyzed the cellular mechanisms that may be responsible for this relationship, with a goal of highlighting areas of research that may have significant translational potential.
    Plastic and reconstructive surgery. 07/2014; 134(1):154e-160e.
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    ABSTRACT: Introduction: Although obesity is a major clinical risk factor for lymphedema, the mechanisms that regulate this effect remain unknown. Recent reports have demonstrated that obesity is associated with acquired lymphatic dysfunction. The purpose of this study was to determine how obesity induced lymphatic dysfunction modulates the pathologic effects of lymphatic injury in a mouse model. Methods: We used a diet-induced model of obesity in adult male C57BL/6J mice in which experimental animals are fed a high fat diet and controls are fed a normal chow diet for 8-10 weeks. We then surgically ablated the superficial and deep lymphatics of the mid-portion of the tail. Six weeks postoperatively, we analyzed changes in lymphatic function, adipose deposition, inflammation, and fibrosis. We also compared responses to acute inflammatory stimuli in obese and lean mice. Results: Compared with lean controls, obese mice had baseline decreased lymphatic function. Lymphedema in obese mice further impaired lymphatic function and resulted in increased subcutaneous adipose deposition, increased CD45(+) and CD4(+) cell inflammation (p<0.01), and increased fibrosis, but caused no change in the number of lymphatic vessels. Interestingly, obese mice had a significantly increased acute inflammatory reaction to croton oil application. Conclusions: Obese mice have impaired lymphatic function at baseline that is amplified by lymphatic injury. This effect is associated with increased chronic inflammation, fibrosis, and adipose deposition. These findings suggest that obese patients are at higher risk for lymphedema due to impaired baseline lymphatic clearance and an increased propensity for inflammation in response to injury.
    American journal of physiology. Heart and circulatory physiology. 05/2014;
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    ABSTRACT: Indications for radiotherapy in breast cancer treatment are expanding. Long-term satisfaction and health-related quality of life (HR-QOL), important outcomes after alloplastic breast reconstruction and radiation, have not been measured in irradiated patients by using a condition-specific, validated patient-reported outcomes instrument. The aim was to evaluate patient satisfaction and HR-QOL in patients with implant breast reconstruction and radiotherapy. A multicenter cross-sectional survey of patients who underwent implant-based breast reconstruction from three centers in the United States and Canada, with and without radiation, was performed. Satisfaction with breasts, satisfaction with outcome, psychosocial well-being, sexual well-being, and physical well-being outcomes were evaluated using the BREAST-Q(©) (Reconstruction Module). Multivariable analysis was performed to evaluate the effect of radiotherapy on patient satisfaction with breasts with adjustment by patient and treatment characteristics. The response rate was 71 %, with 633 completed questionnaires returned. Mean follow-up was 3.3 years for irradiated patients (n = 219) and 3.7 years for nonirradiated patients (n = 414). Patients with radiation had significantly lower satisfaction with breasts (58.3 vs. 64.0; p < 0.01), satisfaction with outcome (66.8 vs. 71.4; p < 0.01), psychosocial well-being (66.7 vs. 70.9; p < 0.01), sexual well-being (47.0 vs. 52.3; p < 0.01), and physical well-being (71.8 vs. 75.1; p < 0.01) compared with nonirradiated patients. Multivariable analysis confirmed the negative effect of radiotherapy on satisfaction with breasts (β = -2.6; p = 0.03) when adjusted for patient and treatment factors. Radiotherapy has a negative effect on HR-QOL and satisfaction with breasts in patients with implant reconstruction compared with nonirradiated patients. The information provided here can inform decision-making and help set appropriate expectations for patients undergoing implant breast reconstruction and radiation.
    Annals of Surgical Oncology 04/2014; · 4.12 Impact Factor
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    ABSTRACT: Introduction: Lymphedema (LE) is a morbid disease characterized by chronic limb swelling and adipose deposition. Although it is clear that lymphatic injury is necessary for this pathology, the mechanisms that underlie lymphedema remain unknown. Interleukin-6 (IL-6) is a known regulator of adipose homeostasis in obesity and has been shown to be increased in primary and secondary models of lymphedema. Therefore, the purpose of this study was to determine the role of IL-6 in adipose deposition in lymphedema. Methods: The expression of IL-6 was analyzed in clinical tissue specimens and serum from patients with/without LE, as well as in 2 mouse models of lymphatic injury. In addition, we analyzed IL-6 expression/adipose deposition in mice deficient in CD4(+) cells (CD4K0), IL-6 expression (IL-6KO), or mice treated with a small molecule inhibitor of IL-6 or CD4 depleting antibodies, to determine how IL-6 expression is regulated and the effect of changes in IL-6 expression on adipose deposition after lymphatic injury. Results: Patients with LE and mice treated with lymphatic excision of the tail had significantly elevated tissue and serum expression of IL-6 and its down-stream mediator. The expression of IL-6 was associated with adipose deposition and CD4+ inflammation and was markedly decreased in CD4KO mice. Loss of IL-6 function resulted in significantly increased adipose deposition after tail lymphatic injury. Conclusion: Our findings suggest that IL-6 is increased as a result of adipose deposition and CD4(+) cell inflammation in lymphedema. In addition, our study suggests that IL-6 expression in lymphedema acts to limit adipose accumulation.
    AJP Heart and Circulatory Physiology 03/2014; · 4.01 Impact Factor
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    ABSTRACT: Recent trends in U.S. breast oncology and autologous reconstruction, such as greater use of contralateral prophylactic mastectomies and microsurgery, may have increased reconstructive complication rates and costs. Simultaneously, with the increased complexity of autologous reconstruction in the setting of declining reimbursement, there may be market concentration of these procedures to specialized high-volume centers. This study aimed to (1) measure cost of autologous reconstruction in the setting of microsurgical technique, contralateral prophylactic mastectomies, and high-volume centers; and (2) analyze trends in market share of these procedures. Inflation-adjusted hospital charges were analyzed for autologous procedures using the Nationwide Inpatient Sample database (1998 to 2010), including a subgroup of microsurgical cases. Median charges were adjusted by patient case mix and analyzed by outcome, procedure type, and hospital volume using the Mann-Whitney test. Market share was evaluated through examination of trends in hospitals performing autologous reconstruction and procedures at high-volume centers. Median charges for 21,016 autologous reconstructions were $22,198. Costs were higher for bilateral reconstruction ($34,202) and microsurgical cases ($57,449). Hospital charges increased from $20,315 (no complications) to $42,210 when both surgery-specific and systemic complications were present (p < 0.01). High-volume hospitals reduced charges by 7.5 percent and had lower costs in the setting of complications (p < 0.01). The number of hospitals performing autologous reconstructions decreased 35 percent, with increasing annual procedures in high-volume centers (48.3 to 73.3, p < 0.01). Bilateral reconstructions and microsurgical technique are associated with greater health care costs. The market concentration of autologous reconstruction to high-volume centers is associated with reduced charges. The long-term implications of this trend are unknown.
    Plastic and reconstructive surgery 03/2014; 133(3):463-70. · 2.74 Impact Factor
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    ABSTRACT: Although lymph node transplantation has been shown to improve lymphatic function, the mechanisms regulating lymphatic vessel reconnection and functional status of lymph nodes remains poorly understood. The authors developed and used LacZ lymphatic reporter mice to examine the lineage of lymphatic vessels infiltrating transferred lymph nodes. In addition, the authors analyzed lymphatic function, expression of vascular endothelial growth factor (VEGF)-C, maintenance of T- and B-cell zone, and anatomical localization of lymphatics and high endothelial venules. Reporter mice were specific and highly sensitive in identifying lymphatic vessels. Lymph node transfer was associated with rapid return of lymphatic function and clearance of technetium-99 secondary to a massive infiltration of recipient mouse lymphatics and putative connections to donor lymphatics. T- and B-cell populations in the lymph node were maintained. These changes correlated with marked increases in the expression of VEGF-C in the perinodal fat and infiltrating lymphatics. Newly formed lymphatic channels in transferred lymph nodes were in close anatomical proximity to high endothelial venules. Transferred lymph nodes have rapid infiltration of functional host lymphatic vessels and maintain T- and B-cell populations. This process correlates with increased endogenous expression of VEGF-C in the perinodal fat and infiltrating lymphatics. Anatomical proximity of newly formed lymphatics and high endothelial venules supports the hypothesis that lymph node transfer can improve lymphedema by exchanges with the systemic circulation.
    Plastic and reconstructive surgery 02/2014; 133(2):301-10. · 2.74 Impact Factor
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    ABSTRACT: Background Over the past decade there has been a rise in US breast reconstruction rates with a greater expansion in prosthetic based techniques relative to autologous transfer. Immediate reconstruction in high-risk oncologic and surgical patients may be a contributing factor to these trends. Study Design The National Cancer Data Base from the American College of Surgeons and the American Cancer Society was used to identify a breast cancer cohort(1998-2011) treated with mastectomy. The patients were divided into high and low-risk based on presence or absence of historical surgical or oncologic relative contraindications. Reconstructions were categorized as either autologous or implants. To understand trends for each high-risk characteristic, rates were adjusted by 1000 total mastectomies performed for patients within each specific group and analyzed with Poisson regression. Results Information from 1,040,088 patients with mastectomy was included. Rates of high risk features did not change from 1998-2011. The increase in immediate reconstruction rates was greater for high than low-risk patients(IRR 1.09 versus 1.06, p<.05 for both). There was a greater rate increase in implant than autologous reconstructions for both high and low-risk groups. For high risk patients, implant use increased for all features but with the greatest change for elderly, comorbidities, and post-mastectomy radiotherapy(p<.01). For high risk patients autologous tissue use increased significantly for all features except premastectomy radiotherapy. Conclusions Breast reconstruction increased in high-risk surgical and oncologic patients, suggestive of a diminishing set of relative contraindications. Increased implant use in high-risk patients may be a contributing factor towards the preferential national expansion of prosthetic techniques.
    Journal of the American College of Surgeons 01/2014; · 4.50 Impact Factor
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    ABSTRACT: To determine if the presence of bilateral implants, in addition to other anatomic and treatment-related variables, affects coverage of the target volume and dose to the heart and lung in patients receiving postmastectomy radiation therapy (PMRT). A total of 197 consecutive women with breast cancer underwent mastectomy and immediate tissue expander (TE) placement, with or without exchange for a permanent implant (PI) before radiation therapy at our center. PMRT was delivered with 2 tangential beams + supraclavicular lymph node field (50Gy). Patients were grouped by implant number: 51% unilateral (100) and 49% bilateral (97). The planning target volume (PTV) (defined as implant + chest wall + nodes), heart, and ipsilateral lung were contoured and the following parameters were abstracted from dose-volume histogram (DVH) data: PTV D95% > 98%, Lung V20Gy > 30%, and Heart V25Gy > 5%. Univariate (UVA) and multivariate analyses (MVA) were performed to determine the association of variables with these parameters. The 2 groups were well balanced for implant type and volume, internal mammary node (IMN) treatment, and laterality. In the entire cohort, 90% had PTV D95% > 98%, indicating excellent coverage of the chest wall. Of the patients, 27% had high lung doses (V20Gy > 30%) and 16% had high heart doses (V25Gy > 5%). No significant factors were associated with suboptimal PTV coverage. On MVA, IMN treatment was found to be highly associated with high lung and heart doses (both p < 0.0001), but implant number was not (p = 0.54). In patients with bilateral implants, IMN treatment was the only predictor of dose to the contralateral implant (p = 0.001). In conclusion, bilateral implants do not compromise coverage of the target volume or increase lung and heart dose in patients receiving PMRT. The most important predictor of high lung and heart doses in patients with implant-based reconstruction, whether unilateral or bilateral, is treatment of the IMNs. Refinement of radiation techniques in reconstructed patients who require comprehensive nodal irradiation is warranted.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 11/2013; · 1.26 Impact Factor
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    ABSTRACT: The performance of a mastectomy for the treatment or prophylaxis of breast cancer may have long-term implications for both physical and mental well-being in women. The development of breast numbness and phantom breast sensations following mastectomy is well-known; however, relatively little is known about physical morbidity following postmastectomy breast reconstruction. The primary objective of this study was to evaluate the level of physical morbidity experienced following three surgical approaches: mastectomy alone, postmastectomy tissue expander/implant reconstruction, and postmastectomy autogenous tissue reconstruction. We conducted a cross-sectional survey of a sample of women who had undergone mastectomy with or without reconstruction. Chest and upper body morbidity were evaluated using the BREAST-Q. Physical well-being was compared across three types of breast surgery. In total, 308 of 452 women who received a questionnaire booklet returned completed questionnaires. There was an overall difference in physical morbidity attributable to surgical treatment (P < 0.001). Patients who underwent autogenous tissue reconstruction had the highest (i.e., best) mean physical well-being score. Women who underwent expander/implant reconstruction also had less chronic physical morbidity than women who underwent mastectomy alone (P < 0.05). Our findings suggest that women who undergo immediate autogenous tissue reconstruction experience significantly less chest and upper body morbidity than those who undergo either mastectomy with implant-based reconstruction or mastectomy alone. This information can be used to facilitate clinical decision-making, to validate individual experiences of breast cancer survivors, and to inform future innovations to decrease the long-term physical morbidity associated with breast cancer surgery.
    Annals of Surgical Oncology 11/2013; · 4.12 Impact Factor
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    Evan Weitman, Daniel Cuzzone, Babak J Mehrara
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    ABSTRACT: Tissue engineering is the process by which biological structures are recreated using a combination of molecular signals, cellular components and scaffolds. Although the perceived potential of this approach to reconstruct damaged or missing tissues is seemingly limitless, application of these ideas in vivo has been more difficult than expected. However, despite these obstacles, important advancements have been reported for a number of organ systems, including recent reports on the lymphatic system. These advancements are important since the lymphatic system plays a central role in immune responses, regulation of inflammation, lipid absorption and interstitial fluid homeostasis. Insights obtained over the past two decades have advanced our understanding of the molecular and cellular mechanisms that govern lymphatic development and function. Utilizing this knowledge has led to important advancements in lymphatic tissue engineering, which is the topic of this review.
    Future Oncology 09/2013; 9(9):1365-74. · 3.20 Impact Factor
  • Lisa F Schneider, Karly A Kaplan, Babak J Mehrara
    Journal of Plastic Reconstructive & Aesthetic Surgery 08/2013; · 1.44 Impact Factor
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    ABSTRACT: The volume-outcome relationship has not been specifically measured for U.S. autologous breast reconstruction. The authors studied whether there is a relationship between hospital procedural volume and perioperative complication rates. The authors identified (1) patients who underwent total mastectomy with immediate autologous reconstruction from 1998 to 2010 and (2) a subset of microsurgical cases from 2008 to 2010. Hospitals were categorized into quartiles based on number of yearly procedures. Outcomes included surgery-specific and systemic complications. A multivariable model was used to analyze the volume-outcome relationship after adjusting for other variables. Over the 13-year study period, 21,016 immediate autologous reconstructions were recorded. Surgery-specific and systemic complication rates were 13.0 and 7.5 percent, respectively. Ninety-two percent of centers perform a very low (fewer than nine cases per year) or low (nine to 20 cases per year) number of procedures. The highest-volume centers (>44 cases per year) are located in metropolitan areas. An inverse relationship between reconstructive volume and surgery-specific and systemic complications was identified (p < 0.01). In the multivariable analysis, centers with very low, low, and medium case volumes were more likely to have surgery-specific complications than high-volume centers (p < 0.01). Very-low-volume compared with high-volume centers were more likely to have systemic complications (p < 0.01). Higher volume autologous breast reconstruction centers have lower complication rates. The volume-outcome relationship is stronger for surgery-specific than for systemic complications. Geographic disparities are present in the distribution of high-volume centers. Such information can be used to inform best practices and improve access to care. Risk, III.
    Plastic and reconstructive surgery 08/2013; 132(2):192e-200e. · 2.74 Impact Factor
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    ABSTRACT: Autologous fat grafting has been gaining popularity in recent years, although there remains concern regarding the safety and efficacy of the practice for breast surgery. The purpose of this study was to determine national trends for fat grafting to the breast and to establish the frequency and specific techniques of the procedure to provide more supportive data. A questionnaire was e-mailed to 2584 members of the American Society of Plastic Surgeons. Variables included prevalence and applications of fat grafting to the breast. Components of the fat graft protocol were also assessed. Four hundred fifty-six of the 2584 questionnaires were completed. Sixty-two percent of all respondents reported currently using fat grafting for reconstructive breast surgery and 28% of all respondents reported currently using the practice for aesthetic breast surgery. The most common reason cited by respondents for using fat grafting to the breast was as an adjunctive therapy to implant or flap surgery. Fat grafting to the breast is a common procedure most often used in reconstructive operations. The increasing prevalence of fat grafting to the breast indicates a need for collection of clinical data and supports the establishment of a national prospective registry to track outcomes after aesthetic and reconstructive applications.
    Plastic and reconstructive surgery 07/2013; 132(1):35-46. · 2.74 Impact Factor
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    ABSTRACT: Free silicone injection for breast augmentation, which became widespread in the 1960s and continues illicitly to this day, has well-known adverse effects. In this retrospective chart review of 14 patients treated for silicone mastitis from 1990 to 2002, we present our experience with the surgical management of patients with silicone mastitis. All the patients were women, ranging in age from 49 to 76 years old (mean age = 58.8). Patients presented to us a mean of 29.9 years after their free silicone breast injection. Treatment modalities were analyzed, and, specifically, methods of breast reconstruction involving autologous tissue transfers, implants, or a combination were evaluated. The majority of patients (12 of 14) required mastectomies for extensive silicone-infiltrated tissues. The remaining two patients had focal areas of disease and were successfully treated with excision and local breast parenchyma flaps. Autologous reconstruction was performed with a total of 20 flaps, including 12 free transverse rectus abdominis myocutaneous flaps, 4 free superior gluteal artery perforator (SGAP) flaps, and 4 pedicled latissimus dorsi (LD) flaps. Two patients had bilateral implant-based breast reconstruction. A variety of reconstructive options are available for patients presenting with silicone mastitis. Once an appropriate breast cancer workup has been performed, the surgical goal is to excise as much of the silicone-infiltrated tissues as possible before reconstruction. To our knowledge, this is the first reported series that incorporates the use of SGAP and LD flaps as a means of autologous tissue reconstruction for silicone-infiltrated breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
    Aesthetic Plastic Surgery 06/2013; · 1.26 Impact Factor

Publication Stats

4k Citations
472.99 Total Impact Points

Institutions

  • 2003–2014
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Plastic and Reconstructive Surgical Service
      • • Breast Service
      New York City, New York, United States
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2000–2011
    • University of California, Los Angeles
      • • Department of Surgery
      • • Division of Plastic Surgery
      Los Angeles, CA, United States
    • NYU Langone Medical Center
      • Department of Surgery
      New York City, NY, United States
  • 2009
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2008
    • Royal Free London NHS Foundation Trust
      • Department of Plastic and Reconstructive Surgery
      London, ENG, United Kingdom
    • Louisiana State University Health Sciences Center New Orleans
      New Orleans, Louisiana, United States
    • University of Pittsburgh
      • Department of Plastic and Reconstructive Surgery
      Pittsburgh, PA, United States
    • New York Presbyterian Hospital
      New York City, New York, United States
  • 2002
    • Stanford University
      • Department of Surgery
      Stanford, CA, United States
  • 1998–2002
    • State University of New York Downstate Medical Center
      • Department of Surgery
      Brooklyn, NY, United States
  • 2000–2001
    • Medical College of Wisconsin
      • Department of Plastic Surgery
      Milwaukee, WI, United States
  • 1999–2001
    • American Society of Ophthalmic Plastic and Reconstructive Surgery
      New York City, New York, United States
    • University of Connecticut
      • Department of Surgery
      Mansfield City, CT, United States