All Publications

  • Factors contributing to prolonged drain duration in prepectoral staged implant-based breast reconstruction EUROPEAN JOURNAL OF PLASTIC SURGERY Thawanyarat, K., Shah, J. K., Eggert, G., Rowley, M., Kim, T., Yesantharao, P. S., Turner, E., Thornton, B., Nazerali, R. 2023
  • Factors Contributing to Prolonged Drain Duration in Prepectoral Staged Implant-based Breast Reconstruction Thawanyarat, K., Shah, J. K., Rowley, M., Eggert, G., Kim, T., Nazerali, R. LIPPINCOTT WILLIAMS & WILKINS. 2023: S92
  • The Effect of Postoperative Infection after Implant Breast Reconstruction on Additional Revision Procedures Francis, S., Shah, J. K., Thawanyarat, K., Rowley, M., Kim, T., Sheckter, C., Nazerali, R. LIPPINCOTT WILLIAMS & WILKINS. 2023: S12
  • Racial Disparities in Postoperative Breast Reconstruction Outcomes: A National Analysis. Journal of racial and ethnic health disparities Johnstone, T., Thawanyarat, K., Rowley, M., Francis, S., Camacho, J. M., Singh, D., Navarro, Y., Shah, J. K., Nazerali, R. S. 2023


    Studies have shown that Black patients are more likely to experience complications following breast reconstruction compared to other racial groups. Most of these studies have been conducted on patient populations focusing on either autologous or implant-based reconstruction without possible predictive indicators for complication disparities for all types of reconstruction procedures. The aim of this study is to elucidate disparities among patient demographics by identifying predictors of complications and postoperative outcomes among different racial/ethnic patients undergoing breast reconstruction utilizing multi-state, multi-institution, and national level data.Patients in the Optum Clinformatics Data Mart that underwent all billable forms of breast reconstruction were identified via CPT codes. Demographics, medical history, and postoperative outcome data were collected by querying relevant reports of CPT, ICD-9, and ICD-10 codes. Outcomes analysis was limited to the 90-day global postoperative period. A multivariable logistic-regression analysis was performed to ascertain the effects of age, patient reported ethnicity, coexisting conditions, and reconstruction type on the likelihood of any common postoperative complication occurring. Linearity of the continuous variables with respect to the logit of the dependent variable was confirmed. Odds ratios and corresponding 95% confidence intervals were calculated.From over 86 million longitudinal patient records, our study population included 104,714 encounters for 57,468 patients who had undergone breast reconstruction between January 2003 and June 2019. Black race (relative to White), autologous reconstruction, hypertension, type II diabetes mellitus, and tobacco use were independent predictors of increased likelihood of complication. Specifically, the odds ratios for complication occurrence for Black, Hispanic, and Asian ethnicity (relative to White) were 1.09, 1.03, and 0.77, respectively. Black patients had an overall breast reconstruction complication rate of 20.4%, while the corresponding rate for White, Hispanic, and Asian patients were 17.0%, 17.9%, and 13.2%, respectively.Our analysis of a national-level database shows that Black patients undergoing implant-based or autologous reconstruction have increased risk of complications, likely due to multifactorial components that play a role in the care of this patient population. While higher rates of comorbidities have been cited as a possible cause, providers must consider racial influences involving cultural context, historical mistrust in medicine, and physician/health institution factors that may drive this disparity of outcomes among our patients.

    View details for DOI 10.1007/s40615-023-01599-1

    View details for PubMedID 37074634

    View details for PubMedCentralID 8027914

  • Use of Local Antibiotic Delivery Systems in Tissue Expander and Implant-Based Breast Reconstruction: A Systematic Review of the Literature. Eplasty Makarewicz, N., Lipman, K., Johnstone, T., Shaheen, M., Shah, J. K., Nazerali, R. 2023; 23: e24


    Periprosthetic infections are a debilitating complication of alloplastic breast reconstruction. Local antibiotic delivery for prophylaxis and infection clearance has been used by other surgical specialties but rarely in breast reconstruction. Because local delivery can maintain high antibiotic concentrations with lower toxicity risk, it may be valuable for infection prophylaxis or salvage in breast reconstruction.A systematic search of the Embase, PubMed, and Cochrane databases was performed in January 2022. Primary literature studies examining local antibiotic delivery systems for either prophylaxis or salvage of periprosthetic infections were included. Study quality and bias were assessed using the validated MINORS criteria.Of 355 publications reviewed, 8 met the predetermined inclusion criteria; 5 papers investigated local antibiotic delivery for salvage, and 3 investigated infection prophylaxis. Implantable antibiotic delivery devices included polymethylmethacrylate, calcium sulfate, and collagen sponges impregnated with antibiotics. Non-implantable antibiotic delivery methods used irrigation with antibiotic solution into the breast pocket. All studies indicated that local antibiotic delivery was either comparable or superior to conventional methods in both the salvage and prophylaxis settings.Despite varied sample sizes and methodologies, all papers endorsed local antibiotic delivery as a safe, effective method of preventing or treating periprosthetic infections in breast reconstruction.

    View details for DOI 10.1002/bjs5.50324

    View details for PubMedID 37187864

    View details for PubMedCentralID PMC10176462

  • Google Trends and Injectable Products: The Next-Best Tool for Anticipating Patient Concerns in Plastic and Reconstructive Surgery. Archives of plastic surgery Rowley, M. A., Thawanyarat, K., Shah, J. K., Nazerali, R. 2023; 50 (2): 210-212

    View details for DOI 10.1055/s-0043-1762914

    View details for PubMedID 36999157

    View details for PubMedCentralID PMC10049800

  • A recent national analysis of breast reconstruction outcomes in patients with underlying autoimmune connective tissue diseases EUROPEAN JOURNAL OF PLASTIC SURGERY Rowley, M. A., Thawanyarat, K., Shah, J. K., Yesantharao, P. S., Nazerali, R. 2023
  • Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN Johnstone, T., Lipman, K., Makarewicz, N., Shah, J., Turner, E., Posternak, V., Chang, D., Thornton, B., Nazerali, R. 2023; 11 (1)
  • Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction. Plastic and reconstructive surgery. Global open Johnstone, T., Lipman, K., Makarewicz, N., Shah, J., Turner, E., Posternak, V., Chang, D., Thornton, B., Nazerali, R. 2023; 11 (1): e4764


    Periprosthetic infections remain a major challenge for breast reconstruction. Local antibiotic delivery systems, such as antibiotic beads and spacers, have been widely used within other surgical fields, but their use within plastic surgery remains scarce. In this study, we demonstrate the use of antibiotic-impregnated polymethylmethacrylate (PMMA) plates for infection prophylaxis in tissue expander (TE)-based breast reconstruction.A retrospective review of patients who underwent immediate breast reconstruction with prepectoral TEs over the span of 5 years performed by two surgeons was completed, revealing a total of 447 patients. Data pertaining to patient demographics, operative details, and postoperative outcomes were recorded. Fifty patients underwent TE reconstruction with the addition of a PMMA plate (Stryker, Kalamazoo, Michigan) impregnated with tobramycin and vancomycin. Antibiotic plates were removed at the time of TE-to-implant exchange. Patient-matching analysis was performed using the 397 patients without PMMA plates to generate a 50-patient nonintervention cohort for statistical analysis.The intervention cohort (n = 50) and 1:1 patient-matched nonintervention cohort (n = 50) demonstrated no statistically significant differences in patient demographics or operative characteristics other than PMMA plate placement. The rate of operative periprosthetic infection was 4% in the intervention group and 14% in the nonintervention group (P = 0.047). The rate of TE explantation was also reduced in the intervention group (6% versus 18%; P = 0.036). Follow-up averaged 9.1 and 8.9 months for the intervention and nonintervention groups, respectively (P = 0.255).Local antibiotic delivery using antibiotic-impregnated PMMA plates can be safely and effectively used for infection prevention with TE-based breast reconstruction.

    View details for DOI 10.1097/GOX.0000000000004764

    View details for PubMedID 36776590

    View details for PubMedCentralID PMC9911200

  • The Impact of Oncoplastic Reduction on Initiation of Adjuvant Radiation and Need for Reexcision: A Database Evaluation. Annals of plastic surgery Shah, J. K., Lipman, K., Pedreira, R., Makarewicz, N., Nazerali, R. 2022; 89 (6): e11-e17


    INTRODUCTION: Partial breast reconstruction with oncoplastic reduction can provide breast cancer patients with improved aesthetic outcomes after breast conservation therapy. This study evaluates the implications of simultaneous oncoplastic reduction with lumpectomy on complication rates, time to adjuvant radiation therapy, and rates of margin reexcision compared with lumpectomy alone.METHODS: The Clinformatics Data Mart Database is a national deidentified commercial claims data warehouse. From 2003 to 2020, adult female patients were queried to identify patients with a breast cancer diagnosis with International Classification of Disease codes. Among those, current procedural terminology codes were used to identify those who underwent lumpectomy alone versus lumpectomy with oncoplastic reduction. Patient demographics, complications, adjuvant oncologic therapies, and need for reexcision were recorded. Patients not continuously enrolled for at least 6 months before and after the index procedure were excluded. Multivariable regression and chi 2 tests were used for statistical analysis.RESULTS: Of 53,165 patients meeting criteria (mean age, 61.4 ± 11.6 years), 1552 (2.9%) underwent oncoplastic reduction. Diagnoses of most nonsurgical complications (seroma, wound dehiscence, postoperative infection, fat necrosis, tissue necrosis, and nonspecified complications of surgical care) were significantly higher in the oncoplastic reduction group, as were rates of some surgical complications (hematoma, seroma, and tissue debridement). However, undergoing oncoplastic reduction did not impact time to adjuvant radiation ( P = 0.194) and protected against positive margins requiring repeat lumpectomy or completion mastectomy ( P < 0.001).CONCLUSIONS: In patients undergoing breast conservation therapy, simultaneous oncoplastic reduction decreased occurrence of positive margins and did not impact time to adjuvant radiation therapy despite increased rates of surgical and nonsurgical complications.

    View details for DOI 10.1097/SAP.0000000000003313

    View details for PubMedID 36416687

  • Transversus abdominus plane blocks do not reduce rates of postoperative prolonged opioid use following abdominally based autologous breast reconstruction: a nationwide longitudinal analysis. European journal of plastic surgery Chattopadhyay, A., Shah, J. K., Yesantharao, P., Ho, V. T., Sheckter, C. C., Nazerali, R. 2022: 1-11


    Background: The transversus abdominus plane (TAP) block reduces postoperative donor site pain in patients undergoing autologous breast reconstruction with an abdominally based flap. This study aimed to determine the effect of TAP blocks on rates of conversion to chronic opioid use.Methods: The Clinformatics Data Mart was queried from 2003 to 2019, extracting adult encounters for abdominally based free and pedicled flaps based on common procedural terminology (CPT) codes. Patients were excluded if they had filled a narcotic prescription 1 year to 30 days prior to surgery. The exposure variable-TAP block-was identified by CPT codes. Outcomes were evaluated using morphine milligram equivalents (MME) from prescriptions filled between 30 days prior to and 30 days after surgery. Chronic opioid use (COU) was defined as receiving 4 unique prescriptions or a 60-day supply between 30 and 180 days after surgery.Results: Of the 4091 patients, (mean age 51.2±9.0 years), 181 (4.4%) had a TAP block placed. Perioperative MMEs/day, postoperative COU, and length of stay did not differ in patients who received a TAP block (p=0.142; p=0.271). Significant predictors of risk of conversion to COU included younger age, pedicled abdominal flap, Elixhauser comorbidity index score>3, filling a psychiatric medication prescription, and filling a benzodiazepine prescription.Conclusions: In patients undergoing autologous breast reconstruction with abdominally based flap reconstruction, TAP blocks do not decrease perioperative MME/day, conversion to chronic opioid use, or length of stay. These data suggest that intraoperative TAP block placement may be a low-yield opioid-reduction strategy.Level of evidence: Level III, risk/prognostic study.

    View details for DOI 10.1007/s00238-022-01996-5

    View details for PubMedID 36212234

  • Retinopathy of Prematurity Treatment Trends from 2003 to 2020 in the United States OPHTHALMOLOGY Khan, S. I., Ryu, W., Wood, E. H., Moshfeghi, D. M., Shah, J., Lambert, S. R. 2022; 129 (10): 1216-1218
  • Retinopathy of Prematurity Treatment Trends from 2003 to 2020 in the United States OPHTHALMOLOGY Khan, S. I., Ryu, W., Wood, E. H., Moshfeghi, D. M., Shah, J., Lambert, S. R. 2022; 129 (10): 1216-1218
  • Retinopathy of Prematurity Treatment Trends from 2003-2020 in the United States. Ophthalmology Khan, S. I., Ryu, W. Y., Wood, E. H., Moshfeghi, D. M., Shah, J. K., Lambert, S. R. 2022


    We used population-based data obtained from Optum's Clinformatics Data Mart Database to characterize recent trends in retinopathy of prematurity (ROP) treatments and outcomes in the United States. Laser photocoagulation was utilized more frequently every year compared to anti-VEGF.

    View details for DOI 10.1016/j.ophtha.2022.06.008

    View details for PubMedID 35714734

  • Labialasty and Insurance: To Cover or Not to Cover? ARCHIVES OF PLASTIC SURGERY-APS Rowley, M., Thawanyarat, K., Shah, J., Nazerali, R. 2022; 49 (02): 285-286
  • Labiaplasty and Insurance: To Cover or Not to Cover? Archives of plastic surgery Rowley, M., Thawanyarat, K., Shah, J., Nazerali, R. 2022; 49 (2): 285-286

    View details for DOI 10.1055/s-0042-1744428

    View details for PubMedID 35832678

    View details for PubMedCentralID PMC9045511

  • Does Higher Intraoperative Fraction of Inspired Oxygen Improve Complication Rates Following Implant-Based Breast Reconstruction? Aesthetic surgery journal. Open forum Rowley, M. A., Thawanyarat, K., Shah, J. K., Cai, L., Turner, E., Manrique, O. J., Thornton, B., Nazerali, R. 2022; 4: ojac039


    Background: The surgical literature debates about whether an average intraoperative fractional inspired level of oxygen (FiO2) greater than 80% confers lower postsurgical complication rates. Although some evidence demonstrates minimal or no difference in short-term mortality or surgical site infections, few studies suggest negative long-term outcomes.Objectives: To the best of our knowledge, this is the first study examining the relationship between intraoperative FiO2 levels and postoperative outcomes in the setting of immediate prepectoral implant-based breast reconstruction.Methods: The authors retrospectively reviewed the complication profiles of 309 patients who underwent prepectoral 2-stage breast reconstruction following mastectomy between 2018 and 2021 at a single institution. Two cohorts were created based on whether intraoperative FiO2 was greater than 80% or less than or equal to 80%. Complication rates between the cohorts were analyzed using Chi-squared test, Fisher's exact test, and multivariable logistic regressions. Variables examined included demographic information; smoking history; preexisting comorbidities; history of chemotherapy, radiation, or axillary lymph node dissection; and perioperative information.Results: Chi-squared and multivariable regression analysis demonstrated no significant difference between cohorts in complication rates other than reoperation. Reoperation rates were significantly increased in the FiO2 greater than 80% cohort (P = 0.018). Multivariable logistic regression also demonstrated that the use of acellular dermal matrix was significantly associated with increased postoperative complications (odds ratio 11.985; P = 0.034).Conclusions: Complication rates did not statistically differ in patients with varying intraoperative FiO2 levels outside of reoperation rates. In the setting of implant-based prepectoral breast reconstruction, hyperoxygenation likely does not lead to improved postsurgical outcomes.Level of Evidence 3:

    View details for DOI 10.1093/asjof/ojac039

    View details for PubMedID 35662907

  • Autologous and Implant-Based Breast Reconstruction Outcomes in Patients with Autoimmune Connective Tissue Diseases Khan, S. I., Yesantharao, P. S., Rowley, M., Shah, J. K., Rogers, A. B., Nazerali, R. ELSEVIER SCIENCE INC. 2021: S204