Curriculum Vitae

Patient Retention and Replacement Trends Following Saline Breast Implants: Are Deflations Inflationary?

Pending Publication

SUMMARY: The purpose of this investigation was to examine the serial operative trends of patients who experienced implant deflation. A retrospective chart review of 285 patients was conducted to examine all patients who experienced saline implant deflation in the setting of a single practice from 2000-2007. Patient age, implant age, approach, final fill volume and re-implant data were examined. In addition, patient charts were examined within the study period to determine the presence of secondary procedures performed at the time of the explants/re-implant as well as tertiary procedures performed after re-implantation. This investigation found that at the time of deflation explant, replacement of implants with silicone after saline deflation is very common (59% of patients). In addition, patients who chose replacement with saline have a significant tendency to replace to silicone (33%) as a tertiary procedure later on.

- Salvatore J. Pacella, MD MBA; W. Grant Stevens, MD FACS; Elliot Hirsch, MD; David A. Stoker, MD FACS

Silicone Breast Implantation: A Retrospective Review of 1012 Implants Placed By a Single Surgeon.

Pending Publication

SUMMARY: The purpose of this study was to examine the outcomes utilizing Mentor fourth generation cohesive silicone breast implants placed by a single surgeon. A retrospective chart review identified all patients who underwent silicone breast augmentation within the Mentor Adjunct Silicone breast implant study by a single surgeon over a thirteen year period. For each patient, basic demographic information, comorbidities and surgical information (implant size, concominant surgery) was recorded. Complication and revision rates in this study compare favorably to the Mentor Core Study (30.6% and 15.4%, respectively). Newer generation cohesive silicone gel implants possess a complication profile that is clearly superior to previous generation silicone gel implants. Placement of implants in subglandular position significantly impact tendency for revision.

- Salvatore J. Pacella, MD MBA; W. Grant Stevens, MD FACS; Andrew J.L. Gear, MD; Celeste McWhorter, David A. Stoker, MD FACS

The Mommy Makeover: Safe and Consistent Outcomes of Successfully Combining Breast surgery and Abdominoplasty.

Pending Publication

SUMMARY: The goal of this study was to evaluate a single centers experience with combined abdominoplasty and cosmetic breast surgery and determine the safety and efficacy of the "mommy makeover" concept. A retrospective review was performed for 268 patients who underwent combined abdominoplasty and cosmetic breast surgery over the last ten years at a single outpatient surgery center. The overall complication rate was 34%; the revision rate was 13%. The mommy makeover procedure exemplifies the concept of combined cosmetic procedures and is one of the most common combinations requested by patients. This study shows that the complication and revision rate of combining abdominoplasty and cosmetic breast surgery is comparable to that reported for individually staged procedures.

- W. Grant Stevens, MD, Remus Repta, MD, Robert Cohen, MD, Steven Vath, MD, David A. Stoker, MD

Outpatient Reduction Mammaplasty: An Eleven-Year Experience.

Published in Aesthetic Surgery Journal, March 2008.

SUMMARY: Recognizing that few outcome studies have been published regarding outpatient breast reduction surgery, this review documented clinical outcomes of reduction mammaplasty performed in an outpatient setting over an 11-year period and compared these results with published normative values in the plastic surgery literature. A retrospective review was undertaken of 884 reduction mammaplasties in 444 patients at a single outpatient surgical center performed by the senior author (W.G.S.) from 1995 through 2006. In all cases, a laser-assisted, inferior pedicle, Wise pattern, reduction mammaplasty was performed. This retrospective series is the largest to date involving outpatient reduction mammaplasty. Complication data derived from this series are comparable to previously published studies and thus support the safety and efficacy of outpatient reduction mammaplasty performed in an accredited facility.

- W. Grant Stevens, Andrew J.L. Gear, David A. Stoker, Elliot M. Hirsch, Robert Cohen, Michelle Spring, Steve D. Vath, Steve A. Schantz, Robert T. Heck

A Review of 100 Consecutive Secondary Augmentation/Mastopexies.

Published in Aesthetic Surgery Journal, September 2007.

SUMMARY: The authors present the indications, surgical techniques, and outcomes in a series of 100 consecutive secondary simultaneous breast augmentation and mastopexy cases from 1992 to 2005. The complications and revision rates in this group of patients were analyzed and compared with primary mastopexy alone, as well as with primary combined augmentation and mastopexy. Independent variables such as patient age, history of smoking, body mass index, type and size of implant, and type of mastopexy incision were analyzed for correlation with complication and revision rates. No major complications were noted in an average of 3.5 years follow-up (range 13 months to 13 years). This study indicates that the procedure is safe and has complication and revision rates comparable to primary augmentation/mastopexy.

- W. Grant Stevens, Michelle Spring, David A. Stoker, Mark E. Freeman, Robert Cohen, Suzanne M. Quardt, Elliot M. Hirsch

Ten Years of Outpatient Abdominoplasties: Safe and Effective.

Published in Aesthetic Surgery Journal, May 2007.

SUMMARY: This study reports the complications and revisions of outpatient abdominoplasties in a large patient population. The charts of 519 consecutive abdominoplasty procedures performed at a single outpatient surgical center over the past 10 years (1996–2006) were reviewed. The most common complication following surgery was seroma (10.6%), followed by unacceptable scarring of the abdominal or umbilical incisions (7.9%). There was no statistically significant difference in complications or revisions when comparing groups based on age, body mass index, operating room time, smoking status, or procedure type. Men were significantly less likely to have a complication when compared with women. This study demonstrates that abdominoplasties may be performed safely and effectively at an accredited outpatient surgery facility.

- W. Grant Stevens, Michelle A. Spring, David A. Stoker, Robert Cohen, Steven D. Vath, Elliot M. Hirsch

Mastopexy Revisited: A Review of 150 Consecutive Cases for Complication and Revision Rates.

Published in Aesthetic Surgery Journal, March 2007.

SUMMARY: To address the limited number of studies regarding revision and complication rates for mastopexy procedures, a retrospective review was performed on a series of 150 consecutive patients who underwent breast lifts. Operations were performed by one of two surgeons (W.G.S. or D.A.S.) in an outpatient surgery center over a 6-year period (1999–2005). Complication and revision rates were observed, and their rates were calculated. There were no major complications. The most common complications were poor scarring (6%) and seroma formation (2.7%). The revision rate was 8.6%; 75% of revisions were for poor scarring. Some of these were performed with the patients under local anesthesia or at the time of a subsequent unrelated surgery. This review indicates that mastopexy may be considered a safe and effective procedure.

- W. Grant Stevens, David A. Stoker, Mark E. Freeman, Suzanne M. Quardt, Elliot M. Hirsch

Is One-Stage Breast Augmentation with Mastopexy Safe and Effective? A Review of 186 Primary Cases.

Published in Aesthetic Surgery Journal, November 2006.

SUMMARY: Although some authors have reported that 1-stage breast augmentation with mastopexy does not increase the risks of surgery, recent literature has raised the question of whether better results might be achieved by staging the procedures. The authors evaluated the safety and efficacy of 1-stage breast augmentation with mastopexy in their own patients by analyzing long-term complication and revision rates. A retrospective chart review was performed of 186 consecutive patients. Complication and revision rates were recorded and calculated. The authors concluded that their review of 1-stage breast augmentation with mastopexy procedures revealed no severe complications. Overall revision rates were comparable to rates for breast augmentation alone and significantly lower than the 100% reoperation rate required for a staged procedure.

- W. Grant Stevens, David A. Stoker, Mark E. Freeman, Suzanne M. Quardt, Elliot M. Hirsch, Robert Cohen

Laser-Assisted Breast Reduction: A Safe and Effective Alternative.

Published in Aesthetic Surgery Journal, July 2006.

SUMMARY: A retrospective chart review was conducted of a series of 367 consecutive patients who underwent inferior pedicle laser-assisted breast reduction surgery at a single outpatient facility from 1995 through 2004. No major complications were noted in the review, with a total of 47 minor complications occurring in 42 patients. Minor complications assessed included seroma, hematoma, infection, dog-ear, and incisional wound breakdown. Complication rates for the series of patients who underwent laser-assisted breast reduction surgery were consistent with those reported for non–laser-assisted procedures. These results, combined with the benefits and efficient operating time afforded by laser deepithelialization, indicate that laser-assisted breast reduction surgery can provide an alternative to standard methods of deepithelialization for those surgeons with access to a carbon dioxide laser.

- W. Grant Stevens, Robert Cohen, Steven A. Schantz, David A. Stoker, Steven D. Vath, Elliot M. Hirsch, Robert Heck, Mark E. Freeman

Does Lipoplasty Really Add Morbidity to Abdominoplasty? Revisiting the Controversy with a Series of 406 Cases.

Published in Aesthetic Surgery Journal, July 2005.

SUMMARY: The popularity of plastic surgery “makeover” television programs has increased interest among the public and the medical community in both the positive and negative aspects of combined surgery procedures. The goal of this study was to evaluate the morbidity of abdominoplasty combined with suction-assisted lipoplasty (SAL) compared to the morbidity of abdominoplasty alone. A retrospective review of 406 consecutive abdominoplasty procedures performed by the senior author (W.G.S.) at a single outpatient surgery center was conducted. No statistically significant differences in complication rates were found when comparing abdominoplasty with SAL to abdominoplasty alone. This extensive retrospective study provides further evidence that combining abdominoplasty with SAL does not increase patient morbidity compared to abdominoplasty alone.

- W. Grant Stevens, Robert Cohen, Steven D. Vath, David A. Stoker, Elliot M. Hirsch

Acceleration of Textured Saline Breast Implant Deflation Rate: Results and Analysis of 645 Implants.

Published in Aesthetic Surgery Journal, January 2005

SUMMARY: Although inflatable saline implants have been in use since 1965, few studies have examined their deflation rates over time. This retrospective study analyzes the deflation rate for Mentor inflatable Siltex saline implants for a period of 5 years following implantation. The study group included 645 Siltex inflatable implants placed in 324 patients for primary breast augmentation between 1992 and 1997. The deflation rate of the implants was 0.3% within the first year of implantation, 2.2% within the first 3 years, and 5.3% over 5 years. The observed deflation rate was lower than the expected deflation rate reported in the manufacturer's product insert data sheet. Further studies are needed to ascertain the long-term deflation rates for each type of breast implant.

- W. Grant Stevens, David A. Stoker, David R. Fellows, Elliot M. Hirsch

"Extreme" Cosmetic Surgery: A Retrospective Study of Morbidity in Patients Undergoing Combined Procedures.

Published in Aesthetic Surgery Journal, July 2004

SUMMARY: It is increasingly common for patients to request that multiple cosmetic procedures be performed during a single operation. The advantages of combined procedures include a single recovery period, reduced surgery costs, and faster patient gratification. The goal of this study was to determine whether performance of combined cosmetic surgery procedures results in increased morbidity. 248 abdominoplasties performed by the same surgeon over a 10-year period were reviewed, with no statistically significant differences in complication rates found in patients who had abdominoplasty alone, abdominoplasty combined with breast surgery, abdominoplasty combined with facial surgery, and abdominoplasty combined with both breast and facial surgery. The results of this retrospective review do not indicate that the combination of cosmetic surgical procedures increases morbidity.

- W. Grant Stevens, Steven D. Vath, David A. Stoker

An Integrated Approach to the Repair of Inverted Nipples.

Published in Aesthetic Surgery Journal, May 2004

SUMMARY: Many methods for the correction of the inverted nipple have been described, but no consensus has been reached as to which is the best approach. This article describes an integrated approach to the correction of nipple inversion that minimizes ductal disruption. The authors performed initial nipple eversion using gentle traction with a skin hook. Selective ductal division was performed as necessary to obtain complete eversion with normal projection. To maintain the nipple in an overcorrected position, a nylon traction suture was placed through the center of the nipple and affixed to a stent consisting of a medicine cup and gauze padding. In a series of 21 patients, nipple eversion was maintained after at least 1 year's follow-up.

- W. Grant Stevens, David R. Fellows, Steven D. Vath, David A. Stoker

The Endotine: A New Biodegradable Fixation Device for Endoscopic Forehead Lifts.

Published in Aesthetic Surgery Journal, March 2003

SUMMARY: No single technique for fixation of the scalp after endoscopic forehead lift is universally accepted, and complications such as alopecia and regression of elevation have been reported with all techniques. This report describes the preliminary results of a study of the Endotine 3.5 forehead fixation device. The Endotine 3.5 device consists of a post on the deep side for anchoring it in the skull and five tines on the superior side for engaging the deep scalp tissues. It was tested in 9 patients, with postoperative follow-up ranging from 6 to 8 months. The surgeon evaluated the device for difficulty/ease of use, palpability, postsurgical pain, and wound healing. The Endotine 3.5 device produced a secure fixation without problems or complications, although it was often palpable with moderate degrees of sensitivity. Further studies are under way to evaluate long-term efficacy.

- W. Grant Stevens, David B. Apfelberg, David A. Stoker, Steven A. Schantz

Reinsertability After Breast Prosthesis Pocket Infection

Published in Plastic Reconstructive Surgery, February 1982.

SUMMARY: We report the development of an animal model for the study of S. aureus infection in silicone gel-filled prosthesis pockets. The purpose of this study was to determine (1) whether successful reinsertion of a prosthesis into a contaminated pocket requires a finite recovery period between implant removal and reinsertion, and (2) whether parenteral antibiotic treatment affects the success of reinsertion. All infected pockets were lavaged with saline and none were drained, either after wound closure or after implant reinsertion. The results indicate that a delay of 2 or more hours between lavage and reinsertion protects against implant exposure. Therapeutic parenteral antibiotic treatment neither prevented implant exposure nor altered the effect of temporal delay on reinsertion. These studies coupled with recent clinical reports suggest that women who develop breast pocket infection need not wait months for restoration of breast symmetry.

-- Marsh, J.L., W.G. Stevens, G.L. Smith and D.J. Krogstad

When Should Nerve Gaps Be Grafted, An Experimental Study in Rats

Published in Plastic and Reconstructive Surgery, May 1985.

SUMMARY: In conclusion, animal experiments have shown the following: (1) extensive elevation (mobilization) of a nerve from its bed does not interfere with its capacity to regenerate as long as the longitudinal epineural vessels are preserved, (2) suturing nerve ends under tension has a deleterious effect on the final results, (3) when a segment of nerve has been resected, the remaining nerve and the site of repair can lengthen to accommodate joint extension (within limitations), (4) if there is a segmental loss of nerve and if the nerve ends can be approximated with 10-0 epineural sutures, even if the joints must be fully flexed, the result is better than using a nerve graft, and (5) when a graft is required, it is important to avoid reversing the nerve graft. We believe direct nerve repair is preferred when flexion of the joints and mobilization of the nerve ends permits approximation with 10-0 epineural suture.

-- Stevens, W.G., J.D. Hall, P.M. Weeks and L.V. Young

Three-dimensional imaging of the wrist.

Published in J. Hand Surgery, January 1985

SUMMARY: The objective of this study was to determine the diagnostic quality of three-dimensional images of the carpal bones that could be constructed from raw data obtained from a computerized tomography scan. The quality of raw data collected was determined by collimation, slice interval, the number of projections, and x-ray tube operating specifications. The quality of two-dimensional images that were constructed from the raw data was determined by user-specified parameters including zoom or magnification factor, convolution kernels, and centering. The two-dimensional images were modified by erasure, the level of reconstruction, and animation, which permitted isolation of individual carpal bones, the construction of three-dimensional images viewing the external and internal surfaces of the bones, and the rotation of the images to provide multiple views. Representative images are presented.

-- Weeks, P.M., M.W. Vannier and W.G. Stevens

Musculoskeletal applications of three-dimensional surface reconstructions.

Published in Orthopedic Clinics of North America, July 1985.

SUMMARY: We have applied computer programs originally developed for craniofacial surgical planning and evaluation to complex musculoskeletal problems. These computer programs reformat ordinary CT scans into black and white images of the three-dimensional osseous surfaces found in the scanned volume. These reformatted three-dimensional CT scan images increase the utility of CT scan examinations of complex osseous structures, such as the wrist, spine, hip, knee, and shoulder. The software, which operates on an unmodified commercially available CT scanner, can produce high-quality surface reconstructions from CT scan slices without operator intervention. No special knowledge of the principles used in the reconstruction methods is needed to successfully use the programs.

-- Vannier, M.W., W.G. Totty, W.G. Stevens, P.M. Weeks, D.M. Dye, W.J. Daum, L.A. Gilula, W.A. Murphy and R.A. Knapp

Computerized imaging for soft tissue and osseous reconstruction in the head and neck.

Published in Clinics in Plastic Surgery, April 1985

SUMMARY: Recent developments in computer-aided medical imaging coupled with the related emergence of computer-aided design and manufacturing technology have had a significant effect on our management of patients with congenital and acquired head and neck deformities. In our institution, plain film skull radiography, cephalometry, and pluridirectional tomography have been largely replaced by high-resolution CT scanning augmented by planar reformations and three-dimensional surface reconstructions. A sophisticated computer-assisted radiologic imaging unit has been established to assist the surgeon and researcher. This marriage of advanced radiographic techniques, industrial computer-aided design technology, and clinical surgery have allowed us to better define aberrant anatomy, design new operative solutions for familiar as well as unusual problems, and quantitate changes of surgery and growth over time.

-- Marsh, J.L., M.W. Vannier, W.G. Stevens, J.O. Warren, D. Gayou and D.M. Dye

In vivo delineation of facial fractures: the application of advanced medical imaging technology.

Published in Annals of Plastic Surgery, November 1986

SUMMARY: Advanced medical imaging technology has important advantages over ordinary skull radiography and conventional tomography in the study of facial fractures. Computer-based imaging methods, including computed tomography and magnetic resonance imaging, provide exquisite soft tissue contrast, superior geometrical accuracy, and freedom from overlapping shadows, and permit computer reformating of images. The advantages of computer-based medical imaging for study of facial fractures are identified and illustrated with computed tomographs. Three-dimensional surface reconstruction methods applied to serial high-resolution computed tomography scans of facial fractures are described and evaluated.

-- Marsh, J.L., M.W. Vannier, W. Gado and W.G. Stevens

Osseous anatomy of unilateral coronal synostosis.

Published in The Cleft Palate Journal, April 1986

SUMMARY: High resolution, thin slice computerized tomography (CT) scans with paraxial and three-dimensional surface reconstructions were utilized to document the endocranial, exocranial, and orbital anatomy of non-syndromal unicoronal synostosis (UCS). Eighteen patients with UCS were evaluated qualitatively and quantitatively. Of these, 10 were studied both preoperatively and 1 year postoperatively. The endocranial base in UCS is characterized by a 9 degree angulation toward the synostosis of the anterior cranial base with respect to the posterior cranial base. The exocranial base has a 7 degree angulation toward the synostosis between the midpalatal suture and the posterior cranial base. The locus of angulation appears to be posterior to the anterior clinoids endocranially, and between the maxillopalatopterygoid articulations and the mandibular condyle exocranially. The orbital rim height is greater ipsilateral to the synostosis than contralaterally. The analysis documents the normalizing effect of one of two different surgical procedures upon orbital height. Application of computer assisted medical imaging to the study of UCS has allowed in vivo quantitation of cranial base and orbital dysmorphology for both preoperative assessment and postoperative evaluation.

-- Marsh, J.L., M. Gado, M.W. Vannier and W.G. Stevens