Katie E Weichman

Montefiore Medical Center, New York, New York, United States

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Publications (43)84.1 Total impact

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    ABSTRACT: Background Surgical management of head and neck cancer is resource intensive and physiologically demanding. In patients with incurable disease, although the indications for surgery are not well defined, palliative benefit can be significant. The goal of this investigation was to compare outcomes of patients who underwent resection and reconstruction of head and neck cancer with curative intent with those who underwent similar procedures with palliative intent. Methods A retrospective review of patients who underwent reconstruction for head and neck cancer between 2008 and 2014 was conducted. Patients were divided into curative and palliative groups. Outcomes assessed included postoperative complications and survival. Results A total of 147 patients who underwent 156 operations met inclusion criteria (27 palliative and 129 curative). In both cohorts, the most common histology was squamous cell carcinoma (SCC) and the most common primary tumor site was the oral cavity. There was no significant difference between the cohorts in the rates of systemic and reconstructive complications, postoperative hospital length of stay, 30-day mortality, and flap survival. Overall survival in palliative patients was significantly shorter compared with curative patients (median OS, 6.2 months vs. 56.1 months, respectively; p < 0.0001). Among patients undergoing palliative surgery, patients without carotid involvement and those with non-SCC were significantly more likely to have longer survival. Conclusion Surgical resection with reconstruction is possible in head and neck oncologic patients undergoing palliative treatment. Palliative patients have similar short-term outcomes when compared with patients undergoing resection for curative intent. Quality-of-life and economic implications of these approaches deserve closer scrutiny.
    No preview · Article · Dec 2015 · Journal of Reconstructive Microsurgery
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    ABSTRACT: Objective: The treatment of head and neck cancer has varying impact on postoperative recovery and return of swallowing function. The authors aim to establish screening tools to assist in preoperatively determining the need for gastrostomy tube placement. Methods: The authors prospectively assessed all patients undergoing complex head and neck reconstructive surgery during a 1-year study period. Only patients tolerating an oral diet, without preoperative gastrostomies, were enrolled for study. Eight parameters were assessed including: body mass index (BMI), prealbumin, albumin, smoking history, comorbidities [including coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM)], age, use of microvascular reconstruction, and type of defect. Two specific screening tools were assessed. In the first, a multivariate logistic regression model was employed to determine factor(s) that predict postoperative gastrostomy tube. In a second screening tool, the 8 parameters were scored between 0 to 1 points. The total score obtained for each patient was correlated with postoperative gastrostomy placement. Results: Out of the 60 study patients enrolled in the study, 24 patients (40%) received a postoperative gastrostomy. In the logistic regression model, albumin level was the only factor that was significantly associated with need for postoperative gastrostomy (P < 0.0023). A score of 4 or greater was determined to have a sensitivity of 83% and specificity of 61% for postoperative gastrostomy. Conclusions: Patients with a score of 4 or more with this screening scoring system or those patients with an albumin level <3.5 g/dL were at high risk for postoperative feeding tube placement.
    No preview · Article · Oct 2015 · The Journal of craniofacial surgery

  • No preview · Article · Oct 2015 · Plastic & Reconstructive Surgery

  • No preview · Article · Sep 2015 · Plastic and Reconstructive Surgery

  • No preview · Article · Sep 2015 · Plastic and Reconstructive Surgery

  • No preview · Article · Sep 2015 · Journal of Reconstructive Microsurgery
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    Full-text · Article · Sep 2015
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    ABSTRACT: Background The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies. Methods After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests. Results A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (n = 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes; p < 0.01), and significantly less postoperative pain on postoperative day (POD) 1 (2.8/10 vs. 3.4/10; p = 0.033) and POD2 (2.4/10 vs. 3.0/10; p = 0.037). Furthermore, patients undergoing rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%; p < 0.01) and a trend toward higher incidence of hematoma, venous thrombosis, and arterial thrombosis when compared with rib-sacrificing patients. Conclusions Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks.
    No preview · Article · Aug 2015 · Journal of Reconstructive Microsurgery
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    ABSTRACT: Perioperative infection is the most common and dreaded complication associated with tissue expander (TE) breast reconstruction. Historically, the expansion period was thought to be the time of greatest hazard to the implant. However, recent institutional observations suggest infectious complications occur prior to expansion. This investigation, therefore, was conducted to determine the timing of infectious complications associated with two-stage TE breast reconstructions. Following IRB approval, a retrospective review of all consecutive two-stage immediate TE breast reconstructions at a single institution from November 2007 to November 2011 was conducted. Reconstructions were then divided into two cohorts: those suffering infectious complications and those that did not. Infectious complications including minor cellulitis, major cellulitis, abscess drainage, and explantation were identified. Various operative and patient variables were evaluated in comparison. Eight hundred ninety immediate two-stage TE breast reconstructions met inclusion criteria. Patients suffering infection were older (55.4 years versus 49.3 years; p < 0.001), and more likely to have therapeutic mastectomy (94% versus 61%; p < 0.0001), the use of acellular dermal matrix (ADM; 72.5% versus 54.9%; p = 0.001), and greater initial TE fill (448.6 mL versus 404.7 mL; p = 0.0078). The average time to developing of infectious symptoms was 29.6 days (range 9-142 days), with 94.6% (n = 87) of infections prior to the start of expansion. Perioperative infections in immediate two-stage TE to implant breast reconstructions are significant and occur mostly prior to the start of expansion. Thus, challenging the conventional wisdom that instrumentation during expander filling as the primary cause of implant infections. Possible etiologic factors include greater age, therapeutic mastectomy versus prophylactic mastectomy, larger initial TE fill, and the use of ADM. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Jul 2015 · The Breast Journal

  • No preview · Article · May 2015 · Plastic & Reconstructive Surgery
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    ABSTRACT: During preoperative discussions with breast reconstruction patients, questions often arise about what to expect during the recovery period. However, there is a paucity of data elucidating post-breast reconstruction pain, fatigue, and physical morbidity. This information is important to patient and physician understanding of reconstructive choices and the postoperative recovery process. We sought to evaluate how recovery may vary for patients based on the timing and type of reconstruction. Patients were recruited as part of the Mastectomy Reconstruction Outcomes Consortium (MROC) study, which is a prospective, multicentered National Institute of Health (NIH)-funded study (1RO1CA152192). Here, patients completed the Numerical Pain Rating Scale (NPRS), McGill Pain Questionnaire, and Breast-Q preoperatively, at 1 week, and 3 months postoperatively. Pain, fatigue, and upper body morbidity were evaluated by the type and timing of reconstruction. A total of 2013 MROC study participants had completed a 3-month follow-up, and therefore they were included for the analysis. A total of 1583 (78.6%) and 1517 patients (75.3%) completed surveys at 1 week and 3 months, respectively, post reconstruction. Across all procedure groups, fatigue and physical well-being scores did not return to preoperative levels by 3 months. At 3 months, pain measured by the NPRS differed across procedure types (P = 0.01), with tissue expander/implant (TE/I) having more pain than direct to implant (P < 0.01). Similarly, at 3 months, chest and upper body physical morbidity, as measured by BREAST-Q, differed by procedure types (P < 0.001), with generally less morbidity for autologous reconstruction as compared with TE/Is. For all reconstructive procedure groups, patients did not fully recover at 3 months post surgery. In addition, postoperative pain and upper body physical morbidity vary significantly by reconstructive procedure with patients undergoing TE/I reporting the most distress. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · May 2015 · Plastic and Reconstructive Surgery
  • Katie E Weichman · Leo Urbinelli · Joseph J Disa · Babak J Mehrara
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    ABSTRACT: Breast reduction in patients with a history of lumpectomy and irradiation is controversial because of a heightened risk of infection and wound healing complications. Persistent macromastia or asymmetry remains a problem in this patient population that is commonly not addressed. The authors studied the safety and efficacy of a central mound technique with minimal dissection for breast reduction or mastopexy in patients with a history of breast irradiation. A case-control study of all patients undergoing bilateral breast reduction mammaplasty between 2008 and 2013 at Memorial Sloan Kettering Cancer Center was conducted. Patients who had unilateral breast irradiation and bilateral reduction using the central mound technique were included. Each patient had a control breast and an irradiated breast. Complications and outcomes were analyzed. Thirteen patients were included for analysis. Their average age was 50.23 ± 9.9 years, and average time from irradiation to breast reduction mammaplasty was 41.3 ± 48.5 months (range, 9 to 132 months). The average specimen weight of irradiated breasts was less than that of control breasts; however, this failed to reach statistical significance (254.2 ± 173.5 g versus 386.9 ± 218.5 g; p = 0.099). One patient developed fat necrosis in the previously irradiated breast and underwent biopsy. There was no incidence of nipple necrosis or breast cancer in either irradiated or nonirradiated breasts. Breast reduction mammaplasty in patients who have had irradiation is feasible and can be performed safely in select cases. The central mound technique provides reliable and reproducible results and should be considered in patients with macromastia/asymmetry and a history of irradiation. Therapeutic, III.
    No preview · Article · May 2015 · Plastic and Reconstructive Surgery
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    ABSTRACT: Lower extremity reconstruction following resection of long bone tumors is challenging because of the unique functional demands and growth potential of the lower extremity in children. The use of a free fibula flap inside a massive bone allograft provides a reliable reconstructive option. The authors evaluate the surgical and functional outcomes of using this technique. This is a retrospective review of 12 consecutive patients who underwent reconstruction of segmental femur or tibia defects using a free fibula flap inside a massive bone allograft from 2003 to 2011. Complications and functional outcomes are reported. Twelve patients with a mean age of 15.8 years (range 3 to 49 years) were included in the study. Eight femur defects and four tibia defects were reconstructed. The mean follow up time was 41.4 months. Two constructs were removed because of infection, three patients required bone grafting for nonunion, one patient required an additional operation to excise a skin paddle, and one patient experienced a lower extremity DVT. The mean time to achieve full weight bearing was 14.3 months. The use of a free fibula flap inside a massive bone allograft following bone tumor resection provides an option for lower extremity reconstruction. The allograft component increases the initial strength of the reconstruction while the vascularized fibula component is thought to increase the biologic potential for osteosynthesis and ultimately provide a potentially life-long durable reconstruction. Patients who achieve oncologic control are likely to enjoy a high functional long-term outcome. IV.
    No preview · Article · Apr 2015 · Plastic and Reconstructive Surgery
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    ABSTRACT: Patients undergoing autologous breast reconstruction have higher long-term satisfaction rates compared to those receiving prosthetic reconstructions. Regardless, the majority of patients still undergo prosthetic reconstruction. The purpose of this investigation was to compare outcomes of microsurgical reconstructions to prosthetic reconstructions in thin patients and to evaluate the effect of reconstructive type on quality of life. After obtaining IRB approval, a review of all patients undergoing breast reconstruction at a single institution from November 2007 to May 2012 was conducted. Thin patients (body mass index ≤22 kg/m) were included for analysis and divided into two cohorts: microsurgical reconstruction and tissue expander/implant reconstruction. Once identified, patients were mailed a BREAST-Q survey for response and additionally a retrospective chart review was conducted. A total of 273 patients met inclusion criteria: 81.7% (n=233) underwent tissue expander/implant reconstruction and 18.3% (n=50) underwent microsurgical reconstruction. Patients having microsurgical reconstruction required more secondary revision (48 % (n=12) versus 25.9% (n=28)), autologous fat grafting (32% (n=8) versus 16.9% (n=19)) and a greater volume of fat per injection (147.85 mL versus 63.9 mL (p<0.001)). Furthermore, BREAST-Q responses showed patients undergoing microsurgical reconstruction were more satisfied with their breasts at 71.1 versus 64.9 (p=0.004) but had similar overall satisfaction with reconstruction (73.0 versus 74.8 (p=0.54)). Microsurgical breast reconstruction is efficacious in patients with BMI ≤22 kg/m and when compared to prosthetic reconstruction patients display higher satisfaction with breasts. However, microsurgical reconstructions require more secondary revisionary surgery and the use of autologous fat grafting as an adjunct.
    No preview · Article · Apr 2015 · Plastic and Reconstructive Surgery

  • No preview · Article · Apr 2015 · Plastic & Reconstructive Surgery

  • No preview · Article · Apr 2015 · Plastic & Reconstructive Surgery
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    ABSTRACT: Background Prolonged operative time has been associated with increased postoperative complications and higher costs. Many academic centers have a designated day for didactics that cause cases to start 1 hour later. The purpose of this study is to analyze the late-start effect of microvascular breast reconstructions on operative duration. Methods A retrospective review was performed on all patients who underwent abdomina-based free flap breast reconstruction from 2007 to 2011 and analyzed by those who had surgery on late-start versus normal-start days. Patient demographics, average operative time, postoperative complications, and individual surgeon effects were analyzed. A Student t-test was used to compare operative times with statistical significance set at p < 0.05. A multivariate regression analysis was performed to control for potential confounders. Results A total of 272 patients underwent 461 free flap breast reconstructions. Twenty-one cases were performed on late-start days and 251 cases were performed on normal-start days. Patient demographics and complications were not statistically different between the groups. The average operative time for all reconstructions was 434.3 minutes. The average operative times were significantly longer for late-start days, 517.6 versus 427.3 minutes (p = 0.002). This was true for both unilateral and bilateral reconstructions (432.8 vs. 350.9 minutes, p = 0.05; 551.5 vs. 461.2 minutes, p = 0.007). There were no differences in perioperative complications and multivariate regression showed no statistically significant relationship of confounders to duration of surgery. Conclusion Starting cases 1 hour later can increase operative times. Although outcomes were not affected, we recommend avoiding lengthy procedures on late-start days. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    No preview · Article · Mar 2015 · Journal of Reconstructive Microsurgery
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    ABSTRACT: To decrease the rate of infectious complications, surgeons have begun to use Biopatch (Ethicon, Somerville, N.J.) disks at drain exit sites. The authors investigated whether use of a Biopatch disk could convey a reduction in perioperative infections in patients undergoing immediate tissue expander breast reconstruction. A retrospective review was conducted of all patients undergoing tissue expander/implant breast reconstruction from November of 2010 to November of 2012 at a single institution. Breasts were divided into two cohorts: controls with traditional adhesive dressings and those with Biopatch disks at drain sites. Breasts were compared based on demographics, complications, drain duration, and antibiotic type. A total of 1211 breasts met inclusion criteria. The control group (November of 2010 to October of 2011) included 606 breasts. The Biopatch cohort (November of 2011 to October of 2012) included 605 breasts. When comparing breasts with disks to controls, there were no statistical differences in overall infection (6.2 versus 7.4 percent; p = 0.4235), major infection (4.0 versus 4.3 percent; p = 0.8853), need for explantation (2.2 versus 1.8 percent; p = 0.5372), and mastectomy skin flap necrosis (12.6 versus 14.6 percent; p = 0.3148). However, age greater than 50 years, diabetes mellitus, hypertension, hypercholesterolemia, obesity, history of prior breast irradiation, and mastectomy skin flap necrosis were independent predictors of infectious complications. Biopatch disks do not reduce the rate infectious complications in patients undergoing immediate tissue expander breast reconstruction. Other conventional risks, including medical comorbidities, obesity, and mastectomy skin flap necrosis, remain significantly associated with infectious complications. Therapeutic, III.
    No preview · Article · Jan 2015 · Plastic & Reconstructive Surgery
  • Katie Weichman · Melissa Doft · Alan Matarasso
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    ABSTRACT: Background: Surgeon observation suggested that mastopexy alone resulted in decreased cup size. The purpose of this investigation was to assess change in cup size in women undergoing mastopexy alone. Methods: A retrospective review of a single surgeon's experience from February of 2002 to May of 2011 was completed. Patients underwent mastopexy alone (specimen weight < 150 g per side). Exclusion criteria were prior breast augmentation, implant removal at time of mastopexy, combination breast augmentation-mastopexy, and incomplete follow-up. Patients were surveyed by telephone regarding preoperative and postoperative cup size, changes in bra manufacturer, hormone status, and weight gain/loss, and data were analyzed. Results: Sixty-one patients met inclusion criteria, and 20 completed the survey. Their average age was 46.6 years (range, 35 to 76 years) and average body mass index was 22.8 kg/m(2) (range, 18.2 to 26.4 kg/m(2)). Eighty percent (n = 16) had grade II ptosis and 20 percent (n = 4) had grade III ptosis preoperatively. Average specimen weight per breast was 57.8 g (range, 4 to 149 g). Patients reported an average decrease in cup size of 0.90 cup sizes (range, -3 to +2 cup sizes). Excluding one patient who reported an increase, an average decrease of 1.05 cup sizes (range, 0 to 3 cup sizes) was seen. No patients reported changing bra manufacturer. Conclusions: Mastopexy alone results in an average decrease in one brassiere cup size. This is important for preoperative counseling, because patients should recognize that their actual cup size is smaller than the brassiere they wear, which will be reflected postoperatively despite a relatively stable volume.
    No preview · Article · Jul 2014 · Plastic & Reconstructive Surgery
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    ABSTRACT: Background: The purpose of this investigation was to examine patients with low body mass index (BMI) regarding the feasibility to perform autologous breast reconstruction in such patients, as well as to determine optimal donor sites and evaluate outcomes accordingly. Patients and methods: All patients undergoing microsurgical breast reconstruction were divided into three cohorts based on BMI. Group 1 included patients with BMI greater than or equal to 22 kg/m(2) and was defined "low-normal BMI." Patients with BMI 22 to 25 kg/m(2) were placed in Group 2, labeled as "high-normal BMI." Group 3, defined as "overweight," included patients with BMI greater than 25 kg/m(2), but less than 30 kg/m(2). Patients were then analyzed based on demographics, breast cancer history, intraoperative details, complications, and revisionary surgeries. F-tests, chi-square goodness-of-fit tests, and Freeman-Halton extension of the Fisher exact tests were used for statistical analysis. Results: During the study period, a total of 259 reconstructions were performed. Group 1 included 30 patients (n = 49 flaps), Group 2 included 58 patients (n = 98 flaps), and Group 3 included 69 patients (n = 112 flaps). Patients undergoing nipple-areolar sparing mastectomy were more likely to be in Groups 1 (39% [n = 19]) and 2 (37% [n = 37]) as compared with Group 3 (14.2% [n = 16]) (p < 0.001) as compared with the overweight cohort. Patients with increasing BMI were more likely to undergo abdominally based free flaps as compared with alternative donor sites (Group 1 = 2.26, Group 2 = 7.9, Group 3 = 27 [p < 0.001]). Conclusions: Abdominally based free flaps are possible in the majority of patients, however alternative harvest sites have to be used more frequently in low BMI patients.
    No preview · Article · Jun 2014 · Journal of Reconstructive Microsurgery

Publication Stats

180 Citations
84.10 Total Impact Points

Institutions

  • 2015
    • Montefiore Medical Center
      • Department of Surgery
      New York, New York, United States
    • Hofstra North Shore-LIJ School of Medicine
      New York, New York, United States
    • Albert Einstein College of Medicine
      New York, New York, United States
  • 2012-2015
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Plastic and Reconstructive Surgical Service
      New York, New York, United States
  • 2009-2015
    • CUNY Graduate Center
      New York, New York, United States
  • 2014
    • Cornell University
      Итак, New York, United States
    • Technische Universität München
      München, Bavaria, Germany
  • 2010-2013
    • NYU Langone Medical Center
      • • Department of Plastic Surgery
      • • Department of Surgery
      New York, New York, United States