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ACADEMIC BREAST UBC

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Terence Myckatyn

on 14 February 2017

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Transcript of ACADEMIC BREAST UBC

APPROACHING AN ACADEMIC
PLASTIC SURGERY CAREER

Terence Myckatyn, MD, FACS, FRCSC
Associate Professor, Plastic and Reconstructive Surgery
Director Breast Reconstruction, Aesthetic Surgery
Washington University School of Medicine, St Louis
COLLABORATION
MENTORSHIP
ADAPTABLE
streamline patient care
ensure reconstructive access for all eligible mastectomy patients
optimize timing of administration of reconstruction (immediate vs delayed)
educate colleagues about post-lumpectomy reconstruction
Working knowledge
of other
discipline facilitates
COMMUNICATION
& TRANSLATION
Academic Plastic Surgeon
Clinically relevant questions
Patient-access
Unique plastic surgery funding access
Collaborator
Unique Expertise
"Out of the box" perspectives
Access to services/equipment/other collaborators
Different funding opportunities
COACHABLE
INTERESTED
TALENTED
THE MENTOR
PROVIDES THE ENVIRONMENT AND CAN ...
THE RELATIONSHIP
HARD WORK
&
SERENDIPITY
KNOW YOUR STRENGTHS
CLINICAL VOLUME
AVAILABLE COLLABORATORS
FUNDING
MENTORS
PROXIMITY TO RESOURCES
IDENTIFY DEFICIENCIES
DEVELOP STRATEGIES TO ADDRESS THESE
BUT FOCUS SHOULD BE ON NURTURING ASSETS
Impact of Chemo and Radiation on Remodeling of ADMs
94 breasts
-C/-R; NC/-R; NC/+R; +C/-R; +C/+R
Outcomes:
Baker Grade
Gross Integration
Type I/III Collagen
Cellular infiltration, migration, neovascularization, fibrous encapsulation, scaffold degradation, extracellular matrix deposition
Sirius Red/Fast Green Collagen Staining:
Type I: Red
Type III: Green
IMPACT OF ADMs ON POST-RECONSTRUCTIVE EVENTS, OUTCOME PATHWAYS, AND COST IN STAGED PROSTHETIC BREAST RECONSTRUCTION
2 plastic surgeons ;
N=413 patients, 602 breasts
Microscopic, Molecular and Clinical Evaluation of Capsules and ADMs for Bacteria
26 breasts
91 to 1115 days tissue expander implantation
all Allergan 133MV/MX expanders
Alloderm RTU/RTM and Seri Scaffold
Outcomes :
Capsular Contracture : Baker Grade & applanation tonometry
Scanning Electron Microscopy
ADM and Capsular remodling (H&E)
Collagen content (Fast Green/Sirius Red)
rtPCR with bacterial taxonomy
Live:Dead stain (confocal microscopy)
DISCLOSURES
Consulting and Speakers Fees : Allergan, LifeCell, Andrew Technologies

Fellowship Funding :
LifeCell

Grant Fundings :
PSF, ASERF, LifeCell, Allergan, Barnes Foundation
REGENERATION AFTER
TRAUMATIC PERIPHERAL NERVE INJURY
transgenic models (thy1-XFP/S100-GFP) mice
serial/live imaging
neuromuscular junction imaging
CRAFT
Cancer Recurrence After Fat Transfer
DESIGN :
MULTICENTER CASE COHORT STUDY
INCLUSION CRITERIA:
2006-2011
IDC ; Stage I-III
SITES:
MSK, MDA, Siteman (Wash U), U. Chicago
Total Sample : 3271 patients
All recurrences compared with a 35% random sample (1082 patients)
Cox regression for evaluating possible association of select covariates on time to recurrence
PRELIMINARY RESULTS
76 of 1082 patients fat grafted
Recurrence Hazard Ratio Estimate for fat grafting : 0.98 (95% CI 0.55-1.77) adjusted for BMI, stage, receptor status
TNM stage (p<0.0001) ; age (p=0.03) ; Her2New (p=0.006) and PR (p=0.03)
FAT GRAFTING NOT ASSOCIATED WITH RECURRENCE

Prospective Randomized Control Trial
Investigating Optimal Nipple-Areola
Skin Sparing Mastectomy Incisions
Outcomes:
Breast Q
Mammometrics
Applanation Tonometry
Implant Characteristics
"Spy" Laser-Assisted Angiography
Impact of Timing on Microvascular Anastamosis After Radiation of IMAs
Single surgeon, 2 years:
radiation < 6 weeks ago : no takebacks in 29 consecutive patients
radiation >6 months ago : 2 takebacks in 33 cases
Impact of Tumor:Breast Ratio on Patient Reported Outcomes and Mammometrics Following Mastectomy with Reconstruction versus Breast Conservation Therapy
Involve community plastic surgeons
- develops collegial relationships between interested Plastic Surgeons
- unloads plastic surgeons that are not interested
- "power in numbers" improves
^ outcomes
^ data for studies and grants
^ negotiating cost for device/equipment purchase
Collaboration facilitates becoming a surgeon-scientist
Mentorship
Adaptability

Collaboration
THE MENTEE
EQUIPMENT, TECHNICIAN, TRAINEE RESOURCES
COLLABORATORS
FUNDING
LEARNED HOW TO WRITE GRANTS AND PAPERS
EXPOSURE TO ACADEMIC PLASTIC SURGERY COMMUNITY
IMMEDIATE IMPLANT RECONSTRUCTION
DIEP in Massive Weight Loss Patient
Stacked DIEPs in Radiated Implant Patient
THANK YOU
Less gross ADM incorporation with chemo and radiation
Increased Baker Grade with radiation
Overall reduction in Type I and III collagen over time
Relatively Stable I:III Ratio
Lower I:III ratio in radiated groups
Radiated groups evaluated at later time points due to clinical considerations
Chemotherapy+Radiation significantly reduces :
- Type I Collagen
- Cell Type
- ECM
- Fibrous encapsulation
- Neovascularization
+ADM : odds of explantation increased 1.1x for each 1 kg/m2 increased in BMI
@BMI 28.35 kg/m2 odds of explant 1.2x higher in +ADM group
FK506
Evolution of the
Mentor-Mentee
Relationship

CLINICAL PRACTICE MORPHED INTO A
LARGE VOLUME OF BREAST RECONSTRUCTION AND AESTHETIC SURGERY
ADAPTED EXPERIENCE WITH MICROSCOPY AND TRANSLATIONAL RESEARCH TO BREAST RECONSTRUCTION
COLLABORATION : BIOSTATISTICS & BILLING
COLLABORATION : ENT BIOFILM CORE, MOLECULAR BIOLOGY
COLLABORATION : 4 CANCERS CENTERS, PSF, UNC BIOSTATS CORE
COLLABORATION : WASH U SURGICAL ONCOLOGISTS,
RADIOLOGY, AND RADIATION ONCOLOGY
TAXONOMY FOLLOWING rtPCR
OF BACTERIAL GENE PRODUCTS
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