Mihye Choi, M.D.

Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia
Foley, J. M; Wright, M. J; Gooding, A. L; Ettenhofer, M; Kim, M; Choi, M; Castellon, S. A; Sadek, J; Heaton, R. K; van Gorp, W. G; Marcotte, T. D; Hinkin, C. H
2011 ;23(5):835-843, International psychogeriatrics
Background: This study applies the updated HIV-Associated Neurocognitive Disorders (H
— id: 149727, year: 2011, vol: 23, page: 835, stat: Journal Article,

Defining pseudoptosis (bottoming out) 3 years after short-scar medial pedicle breast reduction
Quan, Michelle; Fadl, Ahmed; Small, Kevin; Tepper, Oren; Kumar, Naveen; Choi, Mihye; Karp, Nolan
2011 Jun;35(3):357-364, Aesthetic plastic surgery
BACKGROUND: Pseudoptosis (bottoming out) is a well-observed phenomenon occurring after all types of breast reduction surgery. The authors' team previously reported the use of three-dimensional (3D) imaging to demonstrate that significant morphologic changes occur in the breast during the first year after short-scar medial pedicle breast reduction. This study extended this evaluation to postoperative year 3. METHODS: Patients undergoing short-scar medial pedicle breast reduction had 3D photographs taken using the Canfield Vectra 3-pod system or the Konica Minolta V910 during postoperative follow-up visits at 1 month, 1 year, 2 years, and 3 years. Patients were assessed for pseudoptosis and breast morphologic changes using the 3D-based measurements. RESULTS: During the 3 year period, 10 patients completed the study. The total breast volume decreased significantly during the first postoperative year by 20.6% (P < 0.05). No change in volume occurred during postoperative years 2 and 3 (P > 0.05). Pseudoptosis was documented in the first postoperative year by a 6% migration of breast tissue from the upper pole to the lower pole of the breast (P < 0.05), without significant change noted during the next 2 postoperative years (P > 0.05). This redistribution of the breast parenchyma correlated with a decrease in breast anteroposterior projection of 10.6 mm (P < 0.05) during the same period, with an insignificant change during postoperative years 2 and 3. During the first postoperative year, 3D comparative analysis recorded a 4.4-mm difference in the 3D topography (P < 0.05) and no further changes thereafter. The angle of breast projection showed a significant decrease of 17% (P < 0.05) in the first postoperative year and no change in subsequent years. CONCLUSION: Three-dimensional photography is a useful tool enabling the plastic surgeon to monitor the postoperative changes in breast morphology objectively. This study provides quantifiable data demonstrating that pseudoptosis and tissue redistribution are limited to the initial postoperative year for patients undergoing short-scar medial pedicle breast reduction. The kinetic change in the breasts during postoperative years 2 and 3 appears to be minimal. Studies comparing the changes in morphology over time with different techniques of breast reduction are underway
— id: 138275, year: 2011, vol: 35, page: 357, stat: Journal Article,

Re-defining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty
Small, Kevin H; Tepper, Oren M; Unger, Jacob G; Kumar, Naveen; Feldman, Daniel L; Choi, Mihye; Karp, Nolan S
2010 Feb;63(2):346-353, Journal of plastic, reconstructive & aesthetic surgery : JPRAS
BACKGROUND: Bottoming out is a well-known phenomenon described with reduction mammaplasty (RM). To date, the evaluation of post-operative bottoming out remains an imprecise science. The following study reports the application of three-dimensional (3D) photography to objectively investigate changes in breast morphology. METHODS: Patients undergoing medial pedicle RM had 3D photographs (Konica Minolta V910) taken during the early and late post-operative period (early=60-120 days; late=400-500 days). 3D images were compared and bottoming out was assessed with 3D parameters and vectors including total breast volume, volumetric tissue distribution above and below the Central (C) plane, distance of the C-plane to the lowest point of the breast, and maximum anterior-posterior projection from the chest wall. RESULTS: Post-operative images from 15 consecutive RM patients showed an average volume of 556+/-144cm3 (early) and 441+/-183cm3 (late). The percent of tissue in the upper pole of the breast changed from the early to late post-operative period (76% vs. 69%, respectively; p<0.01). The distance from a fixed C-plane to the inferior pole significantly increased (42+/-15mm early vs. 51+/-18mm late; p<0.01). AP projection decreased by an average of 6.23mm (p<0.01). The lateral border of the IMF significantly dropped by 6.27mm. CONCLUSIONS: This study objectively describes both the occurrence of bottoming out and the quantitative amount in terms of changes in volumetric distribution, surface topography and breast projection. With 3D photography, plastic surgeons can perform objective evaluation of breast transformation over time, which ultimately will aid in planning to allow for better surgical outcomes
— id: 95658, year: 2010, vol: 63, page: 346, stat: Journal Article,

Mammometrics: the standardization of aesthetic and reconstructive breast surgery
Tepper, Oren M; Unger, Jacob G; Small, Kevin H; Feldman, Daniel; Kumar, Naveen; Choi, Mihye; Karp, Nolan S
2010 Jan;125(1):393-400, Plastic & reconstructive surgery
— id: 106104, year: 2010, vol: 125, page: 393, stat: Journal Article,

Defining the kinetics of breast pseudoptosis after reduction mammaplasty
Choi, Mihye; Unger, Jacob; Small, Kevin; Tepper, Oren; Kumar, Naveen; Feldman, Daniel; Karp, Nolan
2009 May;62(5):518-522, Annals of plastic surgery
Despite the clinical relevance of bottoming out, or pseudoptosis, associated with reduction mammaplasty (RM) its evaluation remains an imprecise science. This study aims to further define the kinetics of postoperative pseudoptosis over an extended period of time, after our previous study investigating pseudoptosis in the early postoperative period. Patients undergoing medial pedicle RM had 3-dimensional photographs taken at year 1 and year 2 intervals postoperatively (year 1 = 300-450 days; year 2 = 700-900 days). Bottoming out was assessed with various 3-dimensional parameters. The total breast volume and the percent tissue distribution in the upper pole of the breast did not change from year 1 to year 2. The anterior-posterior projection as well as vector measurements for internipple distance and sternal notch to nipple distance also remained stable from year 1 to year 2. Although previous data from our group documented the occurrence of bottoming out and continued size reduction over the first postoperative year after breast reduction, the present study shows that pseudoptosis does not seem to occur during the second postoperative year
— id: 100514, year: 2009, vol: 62, page: 518, stat: Journal Article,

Nerve grafts and conduits
Colen, Kari L; Choi, Mihye; Chiu, David T W
2009 Dec;124(6 Suppl):e386-e394, Plastic & reconstructive surgery
Peripheral nerve defects are common. The surgeon faced with these problems must provide the best functional recovery for the patient with the tools provided. The ideal nerve reconstruction would create a tensionless repair with direct coaptation. However, this is not always possible and other techniques must be employed. The alternatives to direct coaptation include nerve autografts, nerve conduits, and tissue-engineered constructs. This article reviews commonly used autogenous nerve grafts and conduits. Autogenous nerve grafts have been utilized in various techniques which include the trunk graft, cable graft, interfascicular graft, and vascularized graft. The nerve conduits reviewed fall into the category of autogenous biological conduits, nonautogenous biological conduits, and nonbiological conduits. New technologies are being developed to enhance peripheral nerve regeneration with the concept that conduits can be enriched and manipulated in the laboratory to promote regeneration of the peripheral nerve. Further clinical studies hold the promise of successful alternatives for treating peripheral nerve injuries
— id: 106201, year: 2009, vol: 124, page: e386, stat: Journal Article,

Wise-pattern breast reconstruction: modification using AlloDerm and a vascularized dermal-subcutaneous pedicle
Derderian, Christopher A; Karp, Nolan S; Choi, Mihye
2009 May;62(5):528-532, Annals of plastic surgery
Immediate implant-based breast mound reconstruction offers many advantages over staged implant reconstruction techniques. For large volume breast reconstruction, a Wise-pattern skin resection may provide very good aesthetic results; however, the submuscular implant pocket is inadequate to cover the inferior pole of the breast. In this patient population, the risk of implant exposure from T-point breakdown is significant. We present our technique of Wise-pattern breast reconstruction using AlloDerm (LifeCell, Branchburg, NJ) and a vascularized dermal-subcutaneous pedicle (DSP) to augment the volume and quality of immediate breast implant coverage, particularly in the area of the T-point suture lines. We reviewed a series of 20 consecutive patients with large breasts who were treated with an immediate implant reconstruction of greater than 400 mL volume using the Wise-pattern with DSP. Preoperative and postoperative 3-dimensional surface scan studies were performed to evaluate breast symmetry. The average volume of breast reconstruction in this study group was 458 mL. T-point breakdown occurred in 5 patients (25%). These patients were treated with local wound care and healed with an excellent aesthetic result. None of these patients required implant removal, implant exchange, or operative debridement. Pre- and postoperative 3-dimensional surface scan analysis of these patients demonstrated comparable differences between the affected and unaffected sides in women undergoing immediate breast implant reconstruction when compared with a matched group of patients undergoing 2-stage breast reconstruction with tissue expanders. Wise-pattern skin-reducing mastectomy is an excellent strategy to provide an aesthetically pleasing, immediate implant breast reconstruction. This technique provides breast symmetry that is at least comparable to that of tissue expander-based, staged implant reconstructions. The reliability of the Wise-pattern technique is significantly improved with the addition of AlloDerm to the muscular pocket and a vascularized DSP to preserve the integrity of the reconstruction in the presence of T-point breakdown
— id: 100515, year: 2009, vol: 62, page: 528, stat: Journal Article,

3D analysis of breast augmentation defines operative changes and their relationship to implant dimensions
Tepper, Oren M; Small, Kevin H; Unger, Jacob G; Feldman, Daniel L; Kumar, Naveen; Choi, Mihye; Karp, Nolan S
2009 May;62(5):570-575, Annals of plastic surgery
Breast augmentation is one of the most common plastic surgery procedures performed in the United States today. Evaluation of postoperative results lacks true objective measurements. The following study reports the application of 3-dimensional (3D) photography to document changes that occur in breast morphology after breast augmentation. Patients undergoing augmentation mammaplasty with a periareolar incision were offered pre- and postoperative 3D photographs. 3D models were constructed and the following parameters were assessed: maximum anterior-posterior projection from the chest wall, angle of breast projection, total breast volume, volumetric tissue distribution in the superior and inferior poles, and surface and vector distance measurements to key landmarks. A completed series of 3D images were obtained from 14 augmentation patients (28 breasts) at an average postoperative day of 143. Saline and silicone implants were used equally (n = 14 for each). Total volume of the breast changed in correlation with the implant size (1.9% difference, P = 0.83). There were no significant changes in the volumetric distribution within the upper and lower poles of the breasts noted between pre- and postoperative scans (P = 0.81). The internal angle of breast projection was found to increase (13.6 degrees, P < 0.01), as did the sternal notch to nipple distance (11 mm, P = 0.018). Anterior-posterior projection significantly increased by 23.3 mm. However, this increase in projection was 20.9% less than expected based on implant dimensions (72.7-58.7 mm, respectively, P < 0.01). This study documents objective changes in breast morphology after augmentation mammaplasty. 3D imaging scans were able to document true changes that occur with breast augmentation including breast volume, the increase in the internal angle of the breast projection, and the sternal notch to nipple distance. 3D photography further highlighted that breast augmentation results in less than expected anterior-posterior projection, possibly due to tissue attenuation occurring anterior to the implant
— id: 100516, year: 2009, vol: 62, page: 570, stat: Journal Article,

An innovative three-dimensional approach to defining the anatomical changes occurring after short scar-medial pedicle reduction mammaplasty
Tepper, Oren M; Choi, Mihye; Small, Kevin; Unger, Jacob; Davidson, Edward; Rudolph, Lauren; Pritchard, Ashley; Karp, Nolan S
2008 Jun;121(6):1875-1885, Plastic & reconstructive surgery
BACKGROUND: Three-dimensional photography of the breast offers new opportunities to advance the fields of aesthetic and reconstructive breast surgery. The following study investigates the use of three-dimensional imaging to assess changes in breast surface anatomy, volume, tissue distribution, and projection following medial pedicle reduction mammaplasty. METHODS: Preoperative and postoperative three-dimensional scans were obtained from patients undergoing short-scar medial pedicle breast reduction. Three-dimensional models were analyzed by topographical color maps, changes in the lowest point of the breast, surface measurements, and the point of maximal projection. Total breast volume and percentage volumetric tissue distribution in the upper and lower poles were also determined. RESULTS: Thirty patients underwent reduction mammaplasty (mean postoperative scan, 80 +/- 5 days). Color maps highlighted the majority of spatial changes in the central, upper poles. Reduction mammaplasty resulted in a significant decrease in the anteroposterior projection of the breast (6.3 +/- 0.2 postoperatively compared with 8.1 +/- 0.2 cm preoperatively; p < 0.01). The point of maximal breast projection was elevated in the cranial-caudal direction (4.8 +/- 0.4 cm; p < 0.01), with a corresponding elevation in the lowest point of the breast (4.8 +/- 0.5 cm; p < 0.01). Volumetric three-dimensional measurements identified a significant change in percentage tissue distribution after reduction mammaplasty (45 +/- 2 percent above the inframammary fold preoperatively versus 76 +/- 2 percent postoperatively; p < 0.01). CONCLUSIONS: This study is the first to demonstrate the technical feasibility and clinical utility of three-dimensional geometric data in medial pedicle breast reduction surgery. This novel approach suggests new opportunities to define long-term operative changes following various breast procedures
— id: 80307, year: 2008, vol: 121, page: 1875, stat: Journal Article,

Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction
Tepper, Oren M; Karp, Nolan S; Small, Kevin; Unger, Jacob; Rudolph, Lauren; Pritchard, Ashley; Choi, Mihye
2008 Nov-Dec;14(6):543-550, Breast journal
The current approach to breast reconstruction remains largely subjective and is based on physical examination and visual-estimates of breast size. Thus, the overall success of breast reconstruction is limited by the inability of plastic surgeons to objectively assess breast volume and shape, which may result in suboptimal outcomes. A potential solution to this obstacle may be three-dimensional (3D) imaging, which can provide unique clinical data that was previously unattainable to plastic surgeons. The following study represents a prospective analysis of patient volunteers undergoing unilateral tissue expander (TE)-implant reconstruction by one of the two senior authors (MC, NSK). All patients underwent unilateral mastectomy with immediate or delayed insertion of a TE, followed by an exchange for a permanent silicone or saline implant. 3D scans were obtained during routine pre- and postoperative office visits. The 3D breast-volume calculations served as a guide for surgical management. Twelve patients have completed 3D-assisted unilateral breast reconstruction to date. These patients represent a wide range of body habitus and breast size/shape; 3D volume range from 136 to 518 cm(3). The mean baseline breast asymmetry in this group was 12.0 +/- 10.8%. Contralateral symmetry procedures were performed in eleven patients, consisting of the following: mastopexy (n = 6), augmentation (n = 1), mastopexy/augmentation (n = 2), and reduction mammoplasty (n = 2). Reconstruction was completed in a total number of 2 (n = 10) or 3 (n = 2) operations. Overall breast symmetry improved at the completion of reconstruction in the majority of patients, with an average postoperative symmetry of 95.1 +/- 4.4% (relative to 88% preoperatively). 3D imaging serves a valuable adjunct to TE-implant breast reconstruction. This technology provides volumetric data that can help guide breast reconstruction, such as in choosing the initial TE size, total volume of expansion, and final implant size/shape. 3D imaging technology also provides benefit as a method for assessing tissue expansion, the need for symmetry or revision procedures, and critically analyzing the final reconstructive outcome
— id: 92771, year: 2008, vol: 14, page: 543, stat: Journal Article,

Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty
Culliford, Alfred T 4th; Spector, Jason A; Flores, Roberto L; Louie, Otway; Choi, Mihye; Karp, Nolan S
2007 Sep 15;120(4):840-844, Plastic & reconstructive surgery
BACKGROUND: Breast reduction is one of the most frequently performed plastic surgical procedures in the United States; more than 160,500 patients underwent the procedure in 2005. Many outpatient reduction mammaplasty patients report the greatest postoperative discomfort in the first 48 hours. The authors' investigated the effect of intraoperative topical application of the long-acting local anesthetic agent bupivacaine (Sensorcaine or Marcaine) on postoperative pain, time to postanesthesia care unit discharge, and postoperative use of narcotic medication. METHODS: In a prospective, randomized, single-blind trial, intraoperative use of Sensorcaine versus placebo (normal saline) was compared. Postoperative pain was quantified using the visual analogue scale, and time to discharge from the postanesthesia care unit was recorded. Patients documented their outpatient pain medication usage. RESULTS: Of the 37 patients enrolled in the study, 20 were treated with intraoperative topical Sensorcaine and 17 received placebo. Patients treated with Sensorcaine were discharged home significantly faster (2.9 hours versus 3.8 hours, p = 0.002). The control arm consistently had higher pain scores in the postanesthesia care unit (although not statistically significant) than the Sensorcaine group using the visual analogue scale system. Furthermore, patients receiving Sensorcaine required significantly less narcotic medication while recovering at home (mean, 3.5 tablets of Vicodin) than the control group (mean, 6.4 tablets; p = 0.001).There were no complications resulting from Sensorcaine usage. CONCLUSIONS: This prospective, randomized, single-blind study demonstrates that a single dose of intraoperative Sensorcaine provides a safe, inexpensive, and efficacious way to significantly shorten the length of postanesthesia care unit stay and significantly decrease postoperative opioid analgesic use in patients undergoing ambulatory reduction mammaplasty
— id: 93588, year: 2007, vol: 120, page: 840, stat: Journal Article,

In search of an accurate and practical approach to 3-dimensional photography of the breast: Reply
Tepper, OM; Choi, M; Karp, NS
2007 OCT ;194(4):565-566, American journal of surgery
— id: 74469, year: 2007, vol: 194, page: 565, stat: Journal Article,

Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction
Tepper, OM; Karp, NS; Small, K; Unger, J; Pritchard, A; Roses, D; Shapiro, R; Guth, A; Axelrod, D; Choi, M
2007 DEC ;106(1):S239-S239, Breast cancer research & treatment
— id: 75806, year: 2007, vol: 106, page: S239, stat: Journal Article,

Three-dimensional imaging in breast reconstruction: a useful adjunct to surgical planning and assessment
Tepper, OM; Karp, NS; Small, K; Rudolph, L; Roses, D; Shapiro, R; Guth, A; Axelrod, D; Choi, M
2006 FEB ;100(2):S119-S119, Breast cancer research & treatment
— id: 71006, year: 2006, vol: 100, page: S119, stat: Journal Article,

Virtual 3-dimensional modeling as a valuable adjunct to aesthetic and reconstructive breast surgery
Tepper, Oren M; Small, Kevin; Rudolph, Lauren; Choi, Mihye; Karp, Nolan
2006 Oct;192(4):548-551, American journal of surgery
Three-dimensional (3D) imaging technology currently is used by various commercial industries as a method for analyzing objects and shapes. Recent work from our group and others offer data to support the use of 3D imaging as a valuable tool in aesthetic and reconstructive breast surgery. We have developed a system for creating 3D breast models that provides clinical data that can help guide surgical management. With 3D breast models, surgeons are able to visually assess the size, shape, contour, and symmetry of the breast, as well as obtain quantitative breast measurements and volumetric calculations. Three-dimensional imaging may be applied to various plastic surgery procedures including breast reconstruction with implant/tissue expanders, local flap reconstruction, free-flap reconstruction, breast augmentation, and breast reduction surgery. The novel application of 3D imaging in these settings represents a significant advance from traditional approaches to aesthetic and reconstructive breast surgery in which surgical procedures are based on 2-dimensional photographs and visual size estimates
— id: 69077, year: 2006, vol: 192, page: 548, stat: Journal Article,

High-pressure hand injection injuries caused by dry cleaning solvents: case reports, review of the literature, and treatment guidelines
Gutowski, Karol A; Chu, Jason; Choi, Mihye; Friedman, David W
2003 Jan;111(1):174-177, Plastic & reconstructive surgery
A previously unreported subset of high-pressure injection injuries, namely those involving solvents used in the garment dry cleaning industry, is presented. Dry cleaning solutions contain isoparaffinic hydrocarbons, methoxypropanol, and dichlorofluoroethane. Although these solvents have limited potential for systemic toxicity, severe local toxicity causing tissue necrosis often results in loss of the injured digit. Proper treatment includes prompt surgical exploration, careful debridement and irrigation, intravenous antibiotics, and in selected cases, high-dose systemic corticosteroids
— id: 64843, year: 2003, vol: 111, page: 174, stat: Journal Article,