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Publications (4)9.98 Total impact

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    ABSTRACT: The authors compared the outcomes of two-stage, acellular dermal matrix (AlloDerm)-assisted prosthetic breast reconstruction including different timings of radiotherapy. A review of two-stage, AlloDerm-assisted, prosthetic breast reconstructions from 2004 to 2010 was performed. All data were recorded prospectively and the study population was stratified by the timing of radiotherapy. Complications were analyzed following first- and second-stage reconstruction. The Spear-Baker classification of capsular contracture was modified for irradiated devices. Reconstructive failure was defined as nonelective removal of a breast prosthesis. : AlloDerm-assisted prosthetic reconstruction was performed in 289 women (428 breasts). After first-stage reconstruction, clinically significant capsular contracture rates (grade III/IV) were higher in the radiation therapy during expansion group and in the radiation therapy before mastectomy group compared with the no-radiation therapy group. Three hundred fifty-three breasts (85.9 percent) successfully underwent second-stage reconstruction, with a median follow-up of 15.2 months. Of those 353 breasts, clinically significant capsular contracture (grade III/IV) was highest in the radiation therapy during expansion group. More often than in the other groups, the radiation therapy during expansion group failed two-stage reconstruction and required flaps in addition or as replacement. In AlloDerm-assisted prosthetic breast reconstruction, irradiated devices demonstrated higher rates of clinically significant capsular contracture following the first stage. These rates declined considerably on completion of reconstruction, with prostheses irradiated during expansion still having the highest frequency of clinically significant capsular contracture. With the follow-up reported, irradiated devices failed breast reconstruction less frequently and required autologous tissue less often than has been historically reported without acellular dermal matrix. Therapeutic, III.
    Plastic and Reconstructive Surgery 07/2012; 130(1):1-9. · 3.33 Impact Factor
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    ABSTRACT: Late seromas surrounding breast implants are becoming an increasingly important issue in breast surgery. The authors report their experience with late seromas and describe their previous management options. A multicenter retrospective review of patients who developed late seromas (clinically presenting seromas without evidence of overt or documented infection more than 1 year after implant operation) was performed. Management, surgical technique, outcomes, complications, culture findings, and cytology results were recorded. Between 2005 and 2010, 28 late seromas were identified in 25 patients. The average interval from the patient's last surgery to seroma onset was 4.7 years; 27 of 28 breasts (96 percent) had a Biocell textured device in place at the time of seroma development. The late seromas in the series were managed as follows: 15 (53.6 percent) by complete capsulectomy, seroma drainage, and new implant placement; three (10.7 percent) by seroma drainage and new implant placement but without capsulectomy; two (7.1 percent) by complete capsulectomy and seroma drainage but without implant replacement; five (17.9 percent) by only ultrasound-guided seroma drainage without the need for surgical intervention; and three (10.7 percent) by antibiotic therapy alone. All cultures and cytology studies were negative for malignancy or infection; 27 of 28 seromas (96 percent) were treated successfully by one of the described approaches. Biocell textured implants were more likely to be associated with late seromas than were smooth shell implants. The overwhelming majority of late seromas appear to be idiopathic, without clear evidence of infection or malignancy. A graduated approach, including several different management strategies, was used to successfully manage these patients. Therapeutic, IV.
    Plastic and Reconstructive Surgery 04/2012; 130(2):423-35. · 3.33 Impact Factor
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    ABSTRACT: To address those patients who do not meet anatomical criteria for nipple-sparing mastectomy, the authors use a staged approach: (1) mastopexy or breast reduction, (2) nipple-sparing mastectomy through the mastopexy incisions after a minimum of 3 to 4 weeks, and (3) the final reconstruction. Fifteen patients underwent nipple-sparing mastectomy at Georgetown University Hospital between 2007 and 2010 after planned or unrelated mastopexy or reduction. An institutional review board-approved retrospective chart review recorded demographic information and outcomes such as skin necrosis and device failure. Fifteen patients (24 breasts) underwent nipple-sparing mastectomy after mastopexy or reduction with an average follow-up of 13 months. The staged procedure was planned in 10 patients [19 breasts (79 percent)] and unplanned, or coincidental, in five [five breasts (21 percent)]. The mastectomy was prophylactic in 17 breasts (71 percent) and therapeutic in seven (29 percent). Four of the 24 operated breasts (17 percent) experienced a complication. Two patients [two breasts (8 percent)] developed skin flap necrosis. Two patients [three breasts (13 percent)] developed minimal partial nipple-areola complex necrosis. One patient [one breast (4 percent)] had an expander explanted for infection related to skin flap necrosis. Fourteen patients [23 breasts (96 percent)] successfully recovered following nipple-sparing mastectomy and prior mastopexy or reduction without residual effects of nipple-areola complex or skin flap necrosis. The authors are comfortable offering the staged approach to nipple-sparing mastectomy to patients with moderately large or ptotic breasts. It may not be suitable for the very large or ptotic breast. Therapeutic, IV.
    Plastic and Reconstructive Surgery 03/2012; 129(3):572-81. · 3.33 Impact Factor
  • S. L. Spear, Steven J. Rottman, Catherine Hannan
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    ABSTRACT: Goals/Purpose: For patients with excessively large or ptotic breasts who are anatomically not candidates for nipple-sparing mastectomy (NSM), we perform a staged mastectomy. In the first stage, a mastopexy or breast reduction is performed, followed by the NSM through the mastopexy incision several weeks to months later. Methods/Technique: We identified twelve patients who underwent a NSM after a planned or unrelated mastopexy/reduction. Patient demographics, indications for mastectomy, timing of the procedures, and outcomes of the procedure were reviewed. Results/Complications: Thirteen patients (20 breasts) underwent NSM after mastopexy or reduction. Average length of follow up was one year (12 to 943 days). The procedure was planned in 8 patients (15 breasts) and unplanned, or coincidental, in 5 patients (5 breasts). All patients underwent immediate reconstruction with tissue expanders (11 patients), or implants (2 patients), and acellular dermal matrix was used in all patients. Average time from mastopexy/breast reduction to NSM was 110.6 days in the planned group and 6 years 20 days in the unplanned group. 4 (22%) of the 20 operated breasts experienced a complication. Two patients (3 breasts, 17% ) developed minimal partial nipple necrosis, however no patients lost a significant portion of their nipples due to necrosis. 2 patients (2 breasts, 11%) developed skin flap necrosis. 1 patient (1 breast, 6%) had a device explanted for infection secondary to skin flap necrosis. Conclusions: Nipple sparing mastectomy in the ptotic and large breast remains a serious challenge with need for further investigation. In carefully selected patients, a staged mastopexy can allow for NSM with acceptable complication rates and good aesthetic outcomes. Photos 3 years post-op Above: pre-op Below: 8 months post-op Tissue Expanders in place Marking for NSM through vertical mastopexy incision S/P Mastopexy Markings for vertical mastopexy Pre-op
    The Aesthetic Meeting 2011 The American Society for Aesthetic Plastic Surgery; 05/2011