2020
Surgical Outcomes of Mastectomy with Immediate Autologous Reconstruction Followed by Radiation
Heller DR, Zhuo H, Zhang Y, Parikh N, Fusi S, Alperovich M, Lannin DR, Higgins SA, Avraham T, Killelea BK. Surgical Outcomes of Mastectomy with Immediate Autologous Reconstruction Followed by Radiation. Annals Of Surgical Oncology 2020, 28: 2169-2179. PMID: 32974699, DOI: 10.1245/s10434-020-09122-0.Peer-Reviewed Original ResearchConceptsPostmastectomy radiation therapyLarge institutional cohortProbability of complicationsImmediate autologous reconstructionAutologous reconstructionMultivariable analysisInstitutional cohortFlap outcomesRadiation-related complicationsRisk of complicationsChest wall asymmetryMethodsMedical recordsNodal radiationMedian followNeoadjuvant chemotherapyPrimary endpointResultsOne hundredSurgical outcomesFat necrosisFlap complicationsImmediate reconstructionReoperationRadiation therapyComplicationsFat graftingWorse overall health status negatively impacts satisfaction with breast reconstruction
Mehta SK, Olawoyin O, Chouairi F, Duy PQ, Mets EJ, Gabrick KS, Le NK, Avraham T, Alperovich M. Worse overall health status negatively impacts satisfaction with breast reconstruction. Journal Of Plastic Reconstructive & Aesthetic Surgery 2020, 73: 2056-2062. PMID: 32972879, DOI: 10.1016/j.bjps.2020.08.093.Peer-Reviewed Original ResearchConceptsBREAST-Q scoresPatient-reported outcomesOverall health statusBreast reconstructionOverall healthASA classificationHealth statusGeneral linear modelAnesthesiologists physical status classificationYale-New Haven HospitalWorse overall health statusBREAST-Q outcomesHealth-related qualityPhysical status classificationNew Haven HospitalEffect of ASAASA 1Independent predictorsPatient factorsPostoperative satisfactionBreast surgeryPatient satisfactionASA 2PatientsRelevant covariatesPatients with psychiatric illness report worse patient‐reported outcomes and receive lower rates of autologous breast reconstruction
Mehta SK, Sheth AH, Olawoyin O, Chouairi F, Gabrick KS, Allam O, Park KE, Avraham T, Alperovich M. Patients with psychiatric illness report worse patient‐reported outcomes and receive lower rates of autologous breast reconstruction. The Breast Journal 2020, 26: 1931-1936. PMID: 32529691, DOI: 10.1111/tbj.13936.Peer-Reviewed Original ResearchConceptsPatient-reported outcomesPsychiatric diagnosisBreast reconstructionBinary logistic regressionAutologous reconstructionReconstructive modalityWorse patient-reported outcomesLogistic regressionBREAST-Q surveysBREAST-Q scoresAutologous breast reconstructionGeneral linear modelQuality of lifeModalities of reconstructionChi-squared testPsychiatric wellASA classificationIndependent predictorsTertiary hospitalInsurance statusImplant reconstructionRisk populationsPatientsDiagnosisModule scoresImpact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction
Le NK, Gabrick KS, Chouairi F, Mets EJ, Avraham T, Alperovich M. Impact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction. The Breast Journal 2020, 26: 1695-1701. PMID: 32337778, DOI: 10.1111/tbj.13849.Peer-Reviewed Original ResearchMeSH KeywordsBreast NeoplasmsFemaleHumansMammaplastyPatient SatisfactionQuality of LifeSocial ClassSurvivorshipConceptsPatients' socioeconomic statusQuality of lifeBreast reconstructionBreast cancerSocioeconomic statusCancer treatmentPatient-reported outcome measuresSingle academic centerInitial cancer treatmentBreast cancer treatmentPopulation health risk factorsHealth risk factorsLow socioeconomic statusHigher socioeconomic statusStudy time periodBaseline comorbiditiesCancer stageRisk factorsOutcome measuresAnalysis of covariancePatient experienceAcademic centersPatientsSignificant positive correlationSatisfaction domainsImpact of Insurance Payer on Type of Breast Reconstruction Performed.
Chouairi F, Mets EJ, Gabrick KS, Dinis J, Avraham T, Alperovich M. Impact of Insurance Payer on Type of Breast Reconstruction Performed. Plastic & Reconstructive Surgery 2020, 145: 1e-8e. PMID: 31881596, DOI: 10.1097/prs.0000000000006315.Peer-Reviewed Original ResearchMeSH KeywordsAdultFemaleHumansIncomeInsurance, HealthMammaplastyMiddle AgedSocioeconomic FactorsUnited StatesConceptsBreast reconstructionBreast reconstruction modalityAcademic medical centerOdds ratioMedical CenterMuscle-sparing transverse rectus abdominis myocutaneous flapPerforator flapTissue expander/implant breast reconstructionExpander/implant breast reconstructionMicrovascular autologous breast reconstructionTransverse rectus abdominis myocutaneous flapPerforator flap breast reconstructionIncome quartileCLINICAL QUESTION/LEVELReconstruction modalitiesSame academic medical centerRectus abdominis myocutaneous flapAutologous breast reconstructionFlap breast reconstructionImplant breast reconstructionHighest income quartileLowest income quartileInsurance typeMicrovascular reconstructionChi-square analysis
2019
Breast reconstruction patterns and outcomes in academic and community practices within a single institution
Gabrick K, Alperovich M, Chouari F, Mets EJ, Reinhart M, Dinis J, Avraham T. Breast reconstruction patterns and outcomes in academic and community practices within a single institution. The Breast Journal 2019, 26: 924-930. PMID: 31788914, DOI: 10.1111/tbj.13693.Peer-Reviewed Original ResearchMeSH KeywordsAgedBreast NeoplasmsFemaleHumansMammaplastyMastectomyMedicareRetrospective StudiesUnited StatesConceptsYale-New Haven HospitalBreast reconstructionMore patientsSingle institutionPlastic surgeonsCommercial insuranceHigh rateRetrospective chart reviewPrevalence of diabetesSimilar complication ratesNipple-sparing mastectomyHigher infection rateAP cohortChart reviewComplication rateCP cohortPostoperative outcomesPreoperative historySurgery ratesPsychiatric comorbidityInsurance statusAutologous reconstructionPractice patternsMedicaid patientsGreater prevalenceInterpreting Complications from Database Research: Limitations of the National Inpatient Sample.
Chouairi F, Mercier MR, Alperovich M. Interpreting Complications from Database Research: Limitations of the National Inpatient Sample. Plastic & Reconstructive Surgery 2019, 144: 943e. PMID: 31403562, DOI: 10.1097/prs.0000000000006132.Peer-Reviewed Original ResearchComplication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction
Chouairi F, Gabrick KS, Avraham T, Markov NP, Alperovich M. Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction. Plastic & Reconstructive Surgery 2019, Publish Ahead of Print: &na;. PMID: 30730496, DOI: 10.1097/prs.0000000000005423.Peer-Reviewed Original ResearchConceptsMastectomy flap necrosisTwo-stage implant breast reconstructionImplant breast reconstructionFlap necrosisBreast reconstructionHigh riskProphylactic mastectomyTherapeutic mastectomyMastectomy indicationExact testTissue expander breast reconstructionCLINICAL QUESTION/LEVELYale-New Haven HospitalPermanent implant reconstructionExpander breast reconstructionTimes higher riskFisher's exact testNew Haven HospitalSignificant differencesBreast reconstruction proceduresBinary logistic regressionReconstructive complicationsBreast groupPerioperative complicationsComplication ratePersistent disparities in breast cancer surgical outcomes among hispanic and African American patients
Mets EJ, Chouairi FK, Gabrick KS, Avraham T, Alperovich M. Persistent disparities in breast cancer surgical outcomes among hispanic and African American patients. European Journal Of Surgical Oncology 2019, 45: 584-590. PMID: 30683449, DOI: 10.1016/j.ejso.2019.01.016.Peer-Reviewed Original ResearchMeSH KeywordsAdultAsianBlack or African AmericanBreast NeoplasmsChemotherapy, AdjuvantComorbidityDiabetes MellitusFemaleHealth Status DisparitiesHispanic or LatinoHospitals, High-VolumeHospitals, UniversityHumansHypertensionMammaplastyMastectomyMiddle AgedNeoadjuvant TherapyObesityPostoperative ComplicationsRadiotherapy, AdjuvantSmokingTreatment OutcomeWhite PeopleConceptsAfrican American patientsAmerican patientsNeoadjuvant chemotherapyComplication ratePost-surgical complication rateHigher overall complication rateHigh rateHigher comorbidity burdenOverall complication ratePrior abdominal surgeryASA class IIIMastectomy flap necrosisRecords of patientsNipple-sparing mastectomyUniversity-affiliated hospitalCancer surgical outcomesHistory of radiationBreast cancer profilesComorbidity burdenReconstructive complicationsPrior radiationOncologic characteristicsPatient demographicsAbdominal surgeryBreast mastectomy
2018
Impact of incidental findings in preoperative CTA imaging for autologous breast reconstruction
Gabrick KS, Godier-Furnemont A, Chouairi F, Avraham T, Alperovich M. Impact of incidental findings in preoperative CTA imaging for autologous breast reconstruction. Journal Of Plastic Reconstructive & Aesthetic Surgery 2018, 72: 789-794. PMID: 30501967, DOI: 10.1016/j.bjps.2018.11.015.Peer-Reviewed Original ResearchMeSH KeywordsBreast NeoplasmsComputed Tomography AngiographyFemaleHumansIncidental FindingsMammaplastyPerforator FlapConceptsAutologous breast reconstructionCTA findingsCT angiographyIncidental findingBreast reconstructionPatient careYale-New Haven HospitalPreoperative CT angiographyNew Haven HospitalMetastatic diseaseMedical managementFurther imagingAdditional imagingGynecologic proceduresReconstructive microsurgeonsPatientsImaging reportsPerforator mappingCareBiopsyImagingFindingsReportMastectomyAngiographyEvolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy
Frey JD, Stranix JT, Chiodo MV, Alperovich M, Ahn CY, Allen RJ, Choi M, Karp NS, Levine JP. Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy. Plastic & Reconstructive Surgery 2018, 141: 1086-1093. PMID: 29659449, DOI: 10.1097/prs.0000000000004271.Peer-Reviewed Original ResearchMeSH KeywordsAdultBreastBreast NeoplasmsFemaleFree Tissue FlapsHumansMammaplastyMastectomy, SubcutaneousMiddle AgedNipplesPatient SatisfactionPerforator FlapPostoperative CarePostoperative ComplicationsReoperationRetrospective StudiesTransplantation, AutologousTreatment OutcomeUltrasonography, DopplerConceptsNipple-sparing mastectomyFree flap reconstructionSkin paddleFlap reconstructionAutologous reconstructionRevision proceduresMuscle-sparing transverse rectus abdominis myocutaneous flapFree flap autologous breast reconstructionAutologous free flap reconstructionTransverse rectus abdominis myocutaneous flapGreater body mass indexCLINICAL QUESTION/LEVELPercentage of flapsProfunda artery perforatorRectus abdominis myocutaneous flapAutologous breast reconstructionBody mass indexInferior epigastric perforatorGreater mean numberMass indexFlap weightMastectomy weightComparing outcomesBreast reconstructionMastectomy reconstruction
2017
Comment on: Complications and Treatment Strategy After Breast Augmentation by Polyacrylamide Hydrogel Injection—Summary of 10 Years’ Clinical Experience
Markov N, Alperovich M, Avraham T. Comment on: Complications and Treatment Strategy After Breast Augmentation by Polyacrylamide Hydrogel Injection—Summary of 10 Years’ Clinical Experience. Aesthetic Plastic Surgery 2017, 42: 410-411. PMID: 29270691, DOI: 10.1007/s00266-017-1035-4.Peer-Reviewed Original Research
2016
“Breast in a Day”
Choi M, Frey JD, Alperovich M, Levine JP, Karp NS. “Breast in a Day”. Plastic & Reconstructive Surgery 2016, 138: 184e-191e. PMID: 27465178, DOI: 10.1097/prs.0000000000002333.Peer-Reviewed Original ResearchConceptsPermanent implant reconstructionNipple-sparing mastectomyMastectomy flap necrosisImplant reconstructionAcellular dermal matrixComplication rateFlap necrosisMajor mastectomy flap necrosisMinor mastectomy flap necrosisDermal matrixImplant sizeCLINICAL QUESTION/LEVELPercent of reconstructionsCommon major complicationPrior radiation therapyGreater complication rateLow complication rateNipple-sparing mastectomiesBody mass indexCommon minor complicationAverage implant sizeMajority of implantsOverall complicationsNipple necrosisMinor complications
2015
Oncologic outcomes after nipple‐sparing mastectomy: A single‐institution experience
Frey JD, Alperovich M, Kim JC, Axelrod DM, Shapiro RL, Choi M, Schnabel FR, Karp NS, Guth AA. Oncologic outcomes after nipple‐sparing mastectomy: A single‐institution experience. Journal Of Surgical Oncology 2015, 113: 8-11. PMID: 26628318, DOI: 10.1002/jso.24097.Peer-Reviewed Original ResearchConceptsNipple-sparing mastectomySkin-sparing mastectomyOncologic outcomesLong-term oncologic outcomesAverage patient ageCommon histologic typePercent of patientsLocoregional recurrence rateSingle institution experienceAverage tumor sizeChest wall recurrenceInvasive ductal carcinomaLocoregional recurrencePatient ageHistologic typeDuctal carcinomaRecurrence rateTumor sizeAverage patientPatientsTherapeutic indicationsMastectomyRecurrenceOutcomesComplex recurrenceNipple‐sparing Mastectomy and Sub‐areolar Biopsy: To Freeze or not to Freeze? Evaluating the Role of Sub‐areolar Intraoperative Frozen Section
Alperovich M, Choi M, Karp NS, Singh B, Ayo D, Frey JD, Roses DF, Schnabel FR, Axelrod DM, Shapiro RL, Guth AA. Nipple‐sparing Mastectomy and Sub‐areolar Biopsy: To Freeze or not to Freeze? Evaluating the Role of Sub‐areolar Intraoperative Frozen Section. The Breast Journal 2015, 22: 18-23. PMID: 26510917, DOI: 10.1111/tbj.12517.Peer-Reviewed Original ResearchConceptsNipple-sparing mastectomyIntraoperative frozen sectionNipple-sparing mastectomiesNipple-areolar complexPermanent paraffin sectionsFrozen sectionsParaffin sectionsBreast cancer resectionRecords of patientsFrozen section resultsCancer resectionDuctal carcinomaProphylactic mastectomyResidual pathologyBreast reconstructionPermanent biopsyMastectomyBiopsyReconstructive planningSeparate proceduresResectionPatientsCarcinomaBreast
2014
Nipple-Sparing Mastectomy in Patients with Prior Breast Irradiation
Alperovich M, Choi M, Frey JD, Lee ZH, Levine JP, Saadeh PB, Shapiro RL, Axelrod DM, Guth AA, Karp NS. Nipple-Sparing Mastectomy in Patients with Prior Breast Irradiation. Plastic & Reconstructive Surgery 2014, 134: 202e-206e. PMID: 25068341, DOI: 10.1097/prs.0000000000000321.Peer-Reviewed Original ResearchConceptsNipple-sparing mastectomyNipple-areola complex necrosisPrior breast irradiationMastectomy flap necrosisHigh-risk procedureBreast irradiationFlap necrosisComplete nipple-areola complex necrosisNipple-sparing mastectomy patientsHigh-risk patientsBody mass indexLatissimus dorsi flapMicrovascular free flapsSignificant differencesMastectomy cohortComplex complicationsImplant explantationMass indexMastectomy patientsCapsular contracturePartial necrosisAutologous reconstructionComplete necrosisIrradiated groupFree flapReply
Alperovich M, Choi M, Karp NS. Reply. Plastic & Reconstructive Surgery 2014, 133: 716e. PMID: 24776578, DOI: 10.1097/prs.0000000000000126.Peer-Reviewed Original Research
2013
Nipple-Sparing Mastectomy in Patients with a History of Reduction Mammaplasty or Mastopexy
Alperovich M, Tanna N, Samra F, Blechman KM, Shapiro RL, Guth AA, Axelrod DM, Choi M, Karp NS. Nipple-Sparing Mastectomy in Patients with a History of Reduction Mammaplasty or Mastopexy. Plastic & Reconstructive Surgery 2013, 131: 962-967. PMID: 23629078, DOI: 10.1097/prs.0b013e3182865ad2.Peer-Reviewed Original ResearchConceptsNipple-sparing mastectomyAuthors' institutionMean body mass indexCLINICAL QUESTION/LEVELMastectomy flap necrosisSubset of patientsNipple-sparing mastectomiesBody mass indexBreast cancer recurrenceLatissimus dorsi flapPresence of cancerNipple-areola complexMass indexProphylactic indicationsFlap necrosisMean agePatient populationBiopsy resultsMastectomy patientsTherapeutic resectionCancer recurrenceNipple viabilityReconstructive outcomesMastectomyReduction mammaplastyMicrosurgical Breast Reconstruction for Nipple-Sparing Mastectomy
Tanna N, Broer PN, Weichman KE, Alperovich M, Ahn CY, Allen RJ, Choi M, Karp NS, Saadeh PB, Levine JP. Microsurgical Breast Reconstruction for Nipple-Sparing Mastectomy. Plastic & Reconstructive Surgery 2013, 131: 139e-147e. PMID: 23358009, DOI: 10.1097/prs.0b013e3182789b51.Peer-Reviewed Original ResearchConceptsNipple-sparing mastectomyMicrosurgical breast reconstructionBreast reconstructionNipple necrosisMastectomy skin flap necrosisFree flap breast reconstructionNew York University Medical CenterCLINICAL QUESTION/LEVELSuperior gluteal artery perforator flapThorough preoperative evaluationGluteal artery perforator flapImmediate breast reconstructionLow complication rateNipple-sparing mastectomiesProfunda artery perforatorSkin flap necrosisBody mass indexFlap breast reconstructionMastectomy specimen weightBreast cancer historyHigh patient satisfactionMajority of flapsChoice of incisionArtery perforator flapMastectomy skin flaps