Plastics

• 1988 – 1992

Vanderbilt University, Nashville, TN - B.A., European History (High honors in History), Minor Degree in Studio Art, Magna Cum Laude

• 1992 – 1996

Tulane University Medical School, New Orleans, LA, Doctor of Medicine

• 1996 – 1998 Categorical Surgical Resident

New York Presbyterian Hospital, Weill-Cornell Medical Center, Department of Surgery, New York, NY

• 1998 – 2001 Research Fellow

Massachusetts General Hospital, Harvard Medical School, Department of Surgery, Boston, MA

• 2001 – 2003 Categorical Surgical Resident

New York Presbyterian Hospital, Weill-Cornell Medical Center, Department of Surgery, New York, NY

• 2003 – 2004 Chief Resident and Clinical Instructor in General Surgery

New York Presbyterian Hospital, Weill-Cornell Medical Center, Department of Surgery, New York, NY

• 2004 – 2006 Resident in Plastic and Reconstructive Surgery

University of Texas, Southwestern Medical Center, Department of Plastic and Reconstructive Surgery, Dallas, TX

Mathes Publications Link

Clip the artery or vein first on a flap? The artery first so the flap isn't engorged with blood

Skin closure 3-0, 4-0 monocryl. Does not “cross midline of the patient or breast” with closing sutures.
For dressings he uses steri-strips and mastisol and he puts the mastisol right on the incisions.

Sutures: for incision use 3-0 and 4-0 monocryl. Stab incisions for liposuction or fat grafting closed with 5-0 fast gut
Dressings: Bra with ABD pads, Binder with ABD pads, Mastasol (NOT benzoin) and steri strips over incisions, steri strip over stab incisions. No need to wrap/compress liposuction sites. Okay for DERMABOND® PRINEO® Skin Closure System.
Equipment: Uses silk tie with two mosquitos for measuring symmetry. 5 staplers.
Markings: Standard breast markings. Mark midline by sternal notch and introits.
Prep: Chloraprep

Marking and Sizing the Nipple: Sit patient up once all incisions are stapled closed. Mark nipple position at area of greatest projection. Lie patient back flat and remove the staples within the marked nipple circle. With the same nipple sizer, make a new circle in the center of the prior marked circle. This smaller circle is now the new nipple position. De-epithelialize the skin within the circle and then cruciate the dermis. Pull nipple through and secure with interrupted 3-0 monocryl and then running 4-0 monocryl. ***Mathes does not like 4-0 suture to cross T-junctions. Do individual running sutures for each limb.

Ties a 3-0 nylon suture the the internal medial and lateral walls of the umbilicus and leaves long tails (this is both to assist in incising and later orienting the umbilicus. Pull up on the 2 sutures and mark a small circle around the umbilicus for incision. Incise down to subQ tissue and stop. He likes to divide the inferior pannus in half and extend it up to the umbilicus incision then get around the stalk while holding the panniculus skin flaps in the other hand. When closing the abdomen pull the 2 sutures on the umbilicus out through the inferior incision. Before completely closing the incision, find the umbilical stalk and make a mark on the overlying skin. Cut out a 2x1cm circle and pull the sutures through, making sure orientation is good. Secure umbilicus with interrupted 3-0 monocryl and ½ buried 4-0 horizontal mattress sutures as needed. Dermabond. (Mathes will also sometimes do an inferior flap incision for the new umbilicus location. It looks like an upside-down shield.)

Intraoperative antibiotics. Antibiotics for home
Sutures: 3-0 PDS for TE and alloderm, 3-0 monocryl deep dermal, 4-0 monocryl subcuticutlar, mastisol and steris
If going pre-pectoral, make sure that there are 2 pieces of alloderm in the room per side.

Pre-Pec- 2 pieces of alloderm sew into IMF and circumferentially at Breast “SFS” dont really sew into muscle Horizontal mattress sutures to secure alloderm, make sure expander is as low as can go the lower the better. Sew alloderm in first superior and inferior than place TE secure inferior and lateral and if can get medial as well. then sew both alloderms together. Place drain. Close

Placing the alloderm at the edge at the sternal edge of the pectoralis muscle may be a good option for Dr. Mathes' cases. Remember that the alloderm should be placed at the, at the IMF and the breast surgeon will violate the IMF on a regular basis. So you should be actually sewing the alloderm to the top of the flap, not to the chest wall.

Places central tab at the breast meridian.
Only sews in 2 tabs for the TE.

Intraoperative antibiotics. No antibiotics for home.
Sutures: 3-0 vicryl for capsule, 3-0 monocryl deep dermal, 4-0 monocryl subcuticutlar

Intraoperative antibiotics. 1 week of Keflex for home.
Close stab incisions with 5-0 fast gut. Steri strip dressing.

MAKE SURE THE BED IS A REFLEX BED… not a chair bed.

“Mark midline once patient is on table but BEFORE prepping If no CT scan, make sure you doppler out perforators BEFORE prepping” - Make sure there is at least 1 perforator on each side of midline. No need to doppler out all of them.
He spends a good amount of time measuring and making sure his abdominal marking elipse is even on each side. An old trick of his is to use the paper that the gloves come in to transfer the marks to the other side as a tracer.

Only remove A FEW staples if you think there is venous congestion. Hematoma should be handled in OR

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed in supine position. Bilateral sequential compression devices were placed and patient was given intravenous antibiotics and pressure points were padded. Surgical timeout was performed.   We marked on the left side for a Wise-type breast reduction. We first began by incising around the nipple using the 42 mm nipple sizer. We then incised our incision markings, we then proceeded to elevate the medial and lateral skin and tissue flaps, deepithelialized the inferior central pedicle. Once we had completed that, we then resected the lateral aspect of the tissue. We then lifted up the superior flap, removed some tissue superiorly and laterally. We then divided the inferior pedicle and noted good blood supply. We then stapled into position after irrigating. We then closed with deep 3-0 Monocryl and running 4-0 Monocryl. Sara Douglass was critical for retraction during the excision of the tissue and performed the majority of the suturing of the breast while I was able to work on the other side. We then marked the nipple position with a 38 mm nipple sizer, surrounded it, deepithelialized it, a cruciate incision, brought the nipples, sewn in with deep 3-0 Monocryl and running 4-0 Monocryl. It was pink and viable. Mastisol and dressings were applied to that area.   On the flap side, we elevated the flap superiorly about 8 cm, and resected approximately 1 cm of the mastectomy flap where it interfaced with the DIEP skin. There were some areas of firmness on the outside that when we elevated we found no evidence of fat necrosis on the flap. It appeared that this was scar in the chest wall. After we had elevated the mastectomy flap and excised the mastectomy skin we sat the patient up and noted that the lateral side was flat and that there was significant scarring. We then dissected laterally and opened up all the areas of scar in the area of the lateral chest. We placed a 15 french drain and secured it with a 3'0 Nylon. The flap was then stapled to the mastectomy flap.   We then performed fat grafting to the upper pole and lateral area using 50 mL of fat, which we had processed by liposuctioning of the lateral flanks using the Revolve system. We then excised an 8 cm area of her lateral scar. The scar was excised with subcutaneous tissue and fat. We then lifted superior and inferior skin flaps and then closed with deep 3-0 Monocryl and running 4-0 Monocryl. Mastisol and Steri-Strip dressings were applied. The patient was then extubated and brought to recovery in stable condition. I was present for all portions of this case. The flap was pink and viable at the end of the case as was the nipple on the reduction side.