Bernard T. Lee, MD, MBA, MPH, FACS
Professor of Surgery, Harvard Medical School
Chief, Plastic and Reconstructive Surgery, BIDMC
Justin Cohen, MD, MHS
Andres Doval, MD
Sherise Epstein, MD
Andreas Lamelas, MD
Joseph Ricci, MD
Qing Ruan, MD
Bao Ngoc Tran, MD
Over the last several years, my basic science research has focused on near infrared imaging (NIR) technologies to identify perfusion characteristics of flaps in reconstructive surgery. In collaboration with John V. Frangioni, MD, PhD, we are using two imaging modalities: Fluorescence-Assisted Resection and Exploration (FLARE) system and Spatial Frequency Domain Imaging (SFDI). We have successfully translated this technology from large animal models to first-in-human clinical trials.
In addition, our clinical research group is examining outcomes and patient satisfaction after breast cancer and reconstructive surgery. Using a large institutional database at BIDMC, as well as national databases from the ACS-NSQIP, we have been able to explore risk factors that lead to complications. In addition, we have been able to understand the relationships between type of reconstruction and patient satisfaction. Most recently, we have been examining patient access, health literacy, and readability of online resources for plastic surgery
Near infrared imaging systems
Our most recent studies have focused on using the FLARE system to examine thrombosis in microsurgery. Using a fluorophore such as indocyanine green, we can identify areas of occlusion and clotting within the vasculature. This enables us to resect and repair vessels and identify reestablished perfusion with the FLARE system. This allows assessment of real-time perfusion characteristics and image guidance during surgery.
In a separate face transplantation model, we are using SFDI to identify perfusion characteristics by targeting tissue constituents (such as hemoglobin). Through the use of this imaging system, we can examine oxygenation of our face transplantation models over a large field of view. In conjunction with surface profilometry, we can provide gradient maps of three-dimensionally complex reconstructive flaps with a single capture snapshot for guidance in the operating room and during surgery. We have successfully translated this technology for use in a clinical trial in patients undergoing microsurgical breast reconstruction.
Patient access and health literacy in plastic and reconstructive surgery
Our clinical outcomes research team has recently begun to examine the area of health literacy and patient access. The AMA and NIH guidelines are for patient-directed health literature to be written at a 6th grade level. Unfortunately, most patient resources are well above this level. Our group has examined online patient resources and their readability for patients. In addition, we have surveyed plastic surgeons to determine how they assess patient literacy and what methods are used to communicate health information. Finally, our group is also designing new patient materials at appropriate reading levels to evaluate their use in patient education.
I am currently the Chief of the Division of Plastic and Reconstructive Surgery at BIDMC. I serve on multiple national committees at the American Society of Plastic Surgeons (In-Service Examination, Scientific Program and Instructional Course, Health Policy, and Healthcare Delivery Committees), American Society for Reconstructive Microsurgery (Treasurer-Elect, Finance, and Future Growth Committees), and American Association of Plastic Surgeons (Program Committee). I am also the co-chair of the performance measures work group on autologous breast reconstruction for the American Society of Plastic Surgeons.
Our research team has been awarded the Commission on Cancer Best Paper Award at the Massachusetts Chapter of the American College of Surgeons meeting, Best Overall Manuscript Award at the Association for Academic Surgery meeting, Joseph E. Murray Best Resident Presentation Award at the New England Society of Plastic and Reconstructive Surgeons meeting, and Best Resident Presentation Award in Breast Reconstruction at the American Society of Plastic Surgeons meeting.
I am currently the Editor-in-Chief of the Journal of Reconstructive Microsurgery and serve on the editorial boards of Annals of Plastic Surgery, Journal of Plastic, Reconstructive, & Aesthetic Surgery, and ePlasty. I am also an editor of a two-volume textbook on reconstructive surgery, Encyclopedia of Flaps.
- Medial row perforators are associated with higher rates of fat necrosis in bilateral DIEP breast reconstruction, Academic Surgical Congress meeting
- The impact of timing of radiation in implant based breast reconstruction: A systematic review, Academic Surgical Congress meeting
- Health literacy in surgery: Breast cancer and reconstruction, Department of Surgery Grand Rounds, American Society of Plastic Surgeons/Plastic Surgery Foundation (ASPS/PSF) Visiting Professor and Lecturer, University of Missouri-Columbia
- Improving outcomes in breast reconstruction, Plastic Surgery Division Rounds, ASPS/PSF Visiting Professor and Lecturer, University of Colorado
- What’s trending at the Journal of Reconstructive Microsurgery and an Introduction to the journal publication process, World Society for Reconstructive Microsurgery Meeting; Seoul, Korea
- Work related musculoskeletal disorders among plastic surgeons: A systematic review, World Society for Reconstructive Microsurgery Meeting; Seoul, Korea
- DIEP flaps in women with abdominal scars: A comparison of complication rates between different abdominal incisions; American Society for Reconstructive Microsurgery
- Does hormone therapy use increase perioperative complications in abdominal based microsurgical breast reconstruction? American Association of Plastic and Reconstructive Surgery
Teaching, Training, and Education
I have been training medical students, general surgery and plastic surgery residents, clinical fellows, and research fellows for over a decade. We have had multiple students from Harvard Medical School (HMS) as well as international students working on our research team. I serve as the course director for the plastic surgery medical student clerkship at BIDMC, as a mentor in the Holmes Society, and as a mentor for medical students and residents applying to plastic surgery residency programs. I was awarded the Young Mentor Award by HMS in 2012, Harvard Plastic Surgery Residency Teaching Award in 2013, and BIDMC Department of Surgery Clinical Research Mentorship Award in 2017.
Selected Research Support
Real-time flap viability monitoring during facial transplantation using SFDI; NIH, 2013-2018; PIs: John V. Frangioni, MD, PhD, and Bernard T. Lee, MD, MBA
Intraoperative near-infrared fluorescence imaging; NIH, 2010-2015; Co-Investigator: Bernard T. Lee, MD, MBA (PI: John V. Frangioni, MD, PhD)
Lee BT, Agarwal JP, Ascherman JA, Caterson SA, Gray DD, Hollenbeck ST, Khan SA, Loeding L, Mahabir RC, Miller AS, Perdikis G, Schwartz JS, Sieling BA, Thoma A, Wolfman J, Wright JL. Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg 2017;140:651-664e.
Wada H, Vargas C, Angelo J, Faulkner-Jones B, Paul MA, Ho O, Lee BT, Frangioni JV. Accurate prediction of tissue viability at post-operative day 7 using only 2 intraoperative sub-second near-infrared fluorescence images. Plast Reconstr Surg 2017; 139(2):354-363.
Ricci JA, Vargas CR, Ho OA, Lin SJ, Tobias AM, Lee BT. Evaluating the use of tissue oximetry to decrease intensive unit monitoring for free flap breast reconstruction. Ann Plast Surg 2017;79:42-46.
Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a meta-analysis. JAMA Surg 2018;153(2):e174947.
Tran BN, Fadayomi A, Lin SJ, Singhal D, Lee BT. Cost analysis of postmastectomy reconstruction: a comparison of two-staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal based perforator free flaps. J Surg Oncol 2017;116:439-447.
Ricci JA, Kamali P, Becherer BE, Curiel D, Wu W, Tobias AM, Lin SJ, Lee BT. Umbilical necrosis rates after abdominal based microsurgical breast reconstruction. J Surg Res 2017;215:257-263.