Browsing by Author "Bhagat, Neel"

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    A case report of gender-affirming mastectomy in a transgender individual with breast cancer
    (AME, 2022-07-30) Bhagat, Neel; Lautenslager, Lauren; Hadad, Ivan; Surgery, School of Medicine
    Background: Gender-affirming mastectomy (GAM), in contrast to simple mastectomy (SM), utilizes preservation of subcutaneous and breast tissue to produce a cosmetically favorable result for transgender patients, however does not remove all future malignancy risk. Here we present a case report of a transmale patient who was evaluated for GAM and subsequently found to have a malignant breast mass, necessitating multi-disciplinary intervention and coordination between breast and plastic surgery teams. This patient's unique and rare presentation with breast cancer prior to GAM emphasized the paucity of previously detailed cases in the literature and demonstrated the likely degree of variability in decision-making for treatment of these patients without universal guidelines for management. Case description: The patient is a 47-year-old African American transgender male who was found to have a 3-cm breast mass on routine pre-operative mammographic screening prior to GAM. Pathology confirmed grade II invasive ductal carcinoma (IDC) and further genetic testing showed the patient was BRCA2 positive. The breast and plastic surgery teams coordinated the GAM to best address the mass while achieving cosmetic goals. This case was complicated by positive nipple margins on intra-operative cold specimen, which necessitated deviation from the initial plan to perform bilateral nipple grafts, and instead utilized excess areolar tissue from the left nipple to reconstruct the contralateral right nipple. Graft survival and overall repair quality at 6 weeks was satisfactory to both patient and provider. Conclusions: This case highlights several of the challenges encountered when considering or performing GAMs in transmale patients with underlying breast cancer. Surgical considerations for these patients differ from cisgender individuals undergoing mastectomy for oncologic breast findings. Further research is needed to better determine the ideal operative practice and ideal follow-up screening for these patients.
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    Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma
    (Thieme, 2024-10-24) Bhagat, Neel; Drake, Connor; Dawson, Steven; Loewenstein, Scott N.; Knox, Kevin R.; Adkinson, Joshua M.; Hassanein, Aladdin H.; Bamba, Ravinder; Surgery, School of Medicine
    Background: There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation. Materials and Methods: The outcomes of 61 patients that underwent lower extremity local flap reconstruction ( n  = 33) or amputation ( n  = 28) between 2014 and 2020 were recorded. Chart reviews were performed to collect perioperative data. Patients were contacted via telephone for participation in the survey portion of our study. PROs were recorded utilizing both the Lower Extremity Functional Scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36). Results: Surveys were completed by 61 patients (response rate 59.2%). The mean time of survey after flap reconstruction or amputation was 2.7 ± 1.4 years. Recent trauma (within 90 days) was the most common indication for local flap coverage ( n  = 23). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared with fasciocutaneous flaps ( p  = 0.021 and p  = 0.022). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS ( p  = 0.01), SF-36 physical functioning ( p  = 0.031), physical role functioning ( p  = 0.031), and emotional role functioning ( p  = 0.047) scores than amputation patients. Conclusion: Patients who underwent local fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. These data suggest that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient-perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.
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    P29. Shifting Applicant Attitudes Towards Virtual Plastic Surgery Residency Interviews
    (Wolters Kluwer, 2022-06-02) Bhagat, Neel; Bamba, Ravinder; Gross, Jeffrey; Hassanein, Aladdin H.; Wooden, William A.; Surgery, School of Medicine
    Background: The COVID-19 pandemic has forced plastic surgery residency programs to transition to virtual interviews for recruitment. In addition to reducing risks of COVID-19 exposure by minimizing travel, virtual interviews are more cost effective and less time consuming for applicants. However, virtual interviews make personal interactions with faculty and residents more challenging for applicants. Assessment of the location and hospital setting is also hindered. This impedes an applicant’s ability to potentially evaluate a program effectively. The purpose of this study is to evaluate the 2021 integrated plastic surgery applicant attitudes towards the current virtual interview process Methods: We surveyed 2021 applicants to our integrated plastic surgery program who interviewed virtually (n=32). Virtual Interview Survey. Applicants were surveyed on how well they became acquainted with our program, faculty, and residents on a scale from 1-5 Results: The survey response was 43.8% (14/32). Most respondents did not have a preference between virtual and in-person interviews (57.1%, n=8). On average, respondents were satisfied with the virtual interview process, rating their overall experience 8.4 (± 1.3) of 10. Applicants responded that they became acquainted with our program, faculty, and residents with respective scores of 3.9 (± 0.62), 3.7 (± 0.73), and 3.6 (± 1.01) on a scale of 1-5. Most applicants did not believe that either a virtual or in-person interview resulted in an advantage to matching (57.1%, n=8). Most applicants responded that virtual interviews allow the opportunity to attend more interviews (78.6%, n=11). Conclusion: We previously published survey data comparing virtual and in-person interviews in the 2020 plastic surgery match during the abrupt transition to virtual interviews during the onset of the pandemic. That study demonstrated lower scores for virtual interviews compared to in-person. However, this survey indicates that applicant attitudes have shifted. Overall, applicants scored the virtual interview process positively in 2021. With the efficiency and financial advantage that virtual interviews offer, it is possible they can become part of the residency selection process even after pandemic restrictions are lifted. Given these findings, residency programs should work on optimizing the virtual interview process.
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    Patient-reported Outcomes after Local Flap Coverage Versus Amputation for Complex Lower Extremity Trauma
    (Wolters Kluwer, 2022) Bhagat, Neel; Drake, Connor; Dawson, Steven; Loewenstein, Scott; Knox, Kevin; Adkinson, Joshua M.; Bamba, Ravi; Surgery, School of Medicine
    PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. RESULTS: Surveys were completed by 65 patients (response rate 60.7%). The mean time of survey after flap reconstruction was 3.2 years. Recent trauma (within 90 days) was the most common indication for local flap coverage (n=26). Flap complications included wound dehiscence (n=8) and infection (n=4). Other flap complications included partial flap necrosis (n=12), total flap necrosis (n=2), and secondary amputation (n=4). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared to fasciocutaneous flaps (p=0.021 and p=0.022 respectively). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS (p=0.017), SF-36 physical functioning (p=0.033), and health change (p=0.050) scores than amputation patients. CONCLUSION: PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. Patients who underwent fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. This data suggests that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.
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    The Role of Early Latissimus Dorsi Tendon Transfers for Shoulder Movement and Stability in Neonatal Brachial Plexus Injury
    (Wolters Kluwer, 2023-10-18) Gross, Jeffrey; Bhagat, Neel; Mulenga, Chilando; Singh, Nikhi; Borschel, Gregory; Adkinson, Joshua; Graduate Medical Education, School of Medicine
    INTRODUCTION: Neonatal brachial plexus injury (BPI) is a rare but devastating complication of birth. An upper trunk BPI can result in the loss of shoulder external rotation and abduction and often leads to glenohumeral joint dysplasia (GJD). The latissimus dorsi/teres major tendon transfer (LTT) is a procedure used to restore external rotation and shoulder abduction and potentially reduce the incidence of GJD. Historically, this tendon transfer has been performed when the child is older and has demonstrated impaired shoulder function. In this study, we sought to assess feasibility and short-term outcomes of LTT combined with BPI reconstruction. METHODS: A retrospective review of patients was performed. Inclusion criteria were patients under 18 years of age at Riley Children’s Hospital with BPI who underwent LTT between 2021-2022. RESULTS: Eighteen patients underwent LTT between 2021-2022 at the mean age of 2.2 +/- 2.2 years. Five patients (27.8%) underwent the transfer concurrently with BPI nerve reconstruction, 8 (44.4%) underwent staged LTT, and 5 (27.8%) patients underwent LTT with no previous or concurrent BPI reconstruction. Of the 8 patients that underwent staged repair, 7/8 (88%) had MRI evidence of GJD prior to their tendon transfer. There were no major complications in any subgroup. Average follow-up was 7.54 months. The mean age at surgery for patients undergoing staged LTT was 2.1 years old compared to 6 months in the concurrent group. In the staged cohort, available post-operative mean AMS scores were 3.5 for shoulder abduction, 1.67 for shoulder external rotation. and 4.83 for shoulder forward flexion. In the concurrent cohort, mean AMS scores were 3.2 for shoulder abduction, 1.8 for external rotation, and 3.6 for shoulder forward flexion. CONCLUSIONS: In this study, we found that LTT can be safely and efficiently combined with BPI reconstruction. Patients in the concurrent surgery cohort achieved similar shoulder functional scores as those in the staged surgery cohort, but these scores were achieved at a younger age (i.e.1.5 years earlier) and without a second surgery. In addition, a simultaneous or early approach may provide the very young pediatric patient shoulder stability needed to prevent GJD while also avoiding the need for a second anesthetic exposure. Future studies will focus on comparative assessment of long-term shoulder functional outcomes.
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    Virtual Interviews for the Independent Plastic Surgery Match: A Modern Convenience or a Modern Misrepresentation?
    (Elsevier, 2020-09-18) Bamba, Ravinder; Bhagat, Neel; Tran, Phu C.; Westrick, Evan; Hassanein, Aladdin H.; Wooden, William A.; Surgery, School of Medicine
    Objective: The virtual interview for residency and fellowship applicants has previously been utilized preliminarily in their respective processes. The COVID-19 pandemic forced many programs to switch to a virtual interview process on short notice. In the independent plastic surgery process, which was underway when the pandemic started, applicants had a heterogeneous experience of in-person and virtual interviews. The purpose of this study was to assess if applicants prefer a virtual interview experience to an in-person interview as well as determine if virtual interview applicants had a different opinion of a program compared to the in-person interview applicants. Design/Setting/Participants: The 2019 to 2020 applicants who interviewed at the Indiana University Independent Plastic Surgery program were administered an anonymous online survey about their interview experience at our program. Results: Our survey response was 60% (18/30). The in-person interview group (n = 10) rated their overall interview experience higher than the virtual interview group (n = 8) 8.8 vs 7.5 (p = 0.0314). The in-person interview group felt they became more acquainted with the program, the faculty, and the residents more than the virtual group (4.7 vs 3.25, p < 0.0001) (4.3 vs 3.25, p = 0.0194) (4.3 vs 2.75, p < 0.0001). The majority of applicants favored in-person interviews (16/18, 88.9%). The in-person interview group spent significantly more money on their interview at our program compared to the virtual interview group ($587 vs $0, p < 0.0001). Conclusion: Our study demonstrated that the virtual interview process was an efficient process for applicants from both a financial and time perspective. However, the virtual interview process left applicants less satisfied with their interview experience. The applicants felt they did not become as acquainted with the program as their in-person counterparts. The virtual interview process may play a large role in residency and fellowship applications in the future, and programs should spend time on how to improve the process.