About

Ara A. Salibian, M.D., is an Associate Professor in the Department of Surgery at UC Davis. His specialties include Surgery, Microsurgery, Reconstructive Surgery, and Plastic Surgery. His professional focus encompasses a broad range of surgical disciplines within plastic and reconstructive surgery, contributing to the department's commitment to excellent patient care by combining medical knowledge, surgical skills, and extensive experience.

Research topics

• Medicine
• Internal medicine
• Surgery
• Radiology

Selected publications

• Recipient vessel selection in autologous breast reconstruction: a narrative review of strategies and clinical implications

  Gland Surgery · 2026-01-01

  articleOpen accessSenior authorCorresponding

  Background and Objective: Autologous breast reconstruction most commonly utilizes free tissue transfer to create a natural-appearing and aesthetically pleasing breast. A critical component of flap-based reconstruction is the selection of recipient vessels, yet the optimal choice, exposure, and technical utilization can vary. This study reviews the different options for recipient vessel selection along with the critical factors that influence decision-making and surgical technique in these cases. Methods: A literature review of PubMed/MEDLINE databases was performed from inception to June 2025 to identify recipient vessels utilized in autologous breast reconstruction. Key words included "recipient vessels", "breast reconstruction", "autologous reconstruction", and "microsurgery". Original and review articles in English were included. Studies were analyzed for discussion of indications, advantages, and drawbacks of one or more recipient options. Key Content and Findings: A multitude of factors influence decision-making in recipient selection and technique including flap choice, mastectomy type, prior operations and surgeon preference. Internal mammary (IM) vessels are the first-line choice. Internal mammary perforators (IMPs) have been explored to reduce morbidity but lack reliability. Thoracodorsal (TD) vessels and other axillary selections can be utilized in appropriately selected patients, typically as second-line options. Conclusions: Advancements in reconstructive techniques have changed the landscape for optimal recipient vessel selection from TD vessels to IM vessels. Options for free flap breast reconstruction continue to evolve toward improving aesthetic outcomes, increasing efficiency, and minimizing recipient site morbidity. Currently, IMP techniques are the forefront of continued innovation, but alternative recipient vessels may be appropriate in select individuals after considering patient factors and surgeon experience.

  PublisherDOI

• Modern approaches to lymphatic surgery: a narrative review

  Translational Breast Cancer Research · 2025-01-01 · 5 citations

  reviewOpen accessSenior author

  Background and Objective: Lymphedema is a chronic, progressive disease secondary to damage to the lymphatic system that results in interstitial fluid accumulation, fat deposition and inflammation. Lymphatic surgery includes a spectrum of procedures aimed to treat these sequelae of lymphedema as well as decrease the risk of lymphedema if performed as prophylactic surgery. We reviewed the literature regarding current surgical treatment options for lymphedema, imaging approaches, and directions the field may head towards both in treatment access and techniques. Methods: We systematically reviewed PubMed, Embase, and Cochrane Library databases to identify approaches to surgical management of lymphedema, including physiologic and reductive methods, as well as challenges that lymphedema patients face for adequate access and insurance coverage to surgical treatment options. Key Content and Findings: Lymphatic surgery can be broadly categorized as physiologic or reductive. Physiologic lymphatic surgery functions to decrease the fluid burden associated with lymphedema and includes lymphovenous bypass as well as vascularized lymph node transplant procedures. Reductive lymphatic surgery reduces the fibroadipose component of lymphedema and include suction lipectomy and excisional procedures. Advances in imaging technology as well as supermicrosurgical techniques have allowed for reproducible, positive clinical outcomes after lymphatic procedures. Access to care and coverage of procedures are persistent challenges in the field, though increasing adoption and research have led to important strides forward to providing patients with this care. Conclusions: Lymphatic surgery can improve symptoms and quality of life for lymphedema patients. A clear understanding of the predominant pathology in a patient (i.e., fluid dominant vs. fat dominant) can help guide counseling and surgical management options for patients. Despite the established benefits for patients, equitable access and insurance coverage for lymphedema surgery are still required.

  PublisherDOI

• Discussion: Impact of Lymphedema Duration on Lymphatic Vessel Quality and Outcomes after Supermicrosurgical Lymphaticovenous Anastomosis

  Plastic & Reconstructive Surgery · 2025-09-24

  article1st authorCorresponding
  PublisherDOI

• Plastic and Reconstructive Surgery Highlights: Plastic Surgery Focus

  Plastic & Reconstructive Surgery · 2025-11-24

  article1st authorCorresponding

  The Plastic Surgery Focus section of Plastic and Reconstructive Surgery, formerly known as Special Topics before 2018, is a unique collection of articles that cover many of the critical aspects of clinical practice, education, and research in plastic surgery. These areas do not necessarily fit neatly into the traditional anatomic subspecialties of the discipline, but instead cover a broad spectrum of important topics, including business, education, global health, technology, and wellness. Now more than ever, plastic surgeons must focus not only on the technical aspects of the specialty but also on the way they are delivered within today’s health care system. As the field, and its surrounding environment, continues to evolve rapidly, the Plastic Surgery Focus section provides the ability to stay up to date with the cutting-edge advancements that continue to shape the specialty. This Plastic and Reconstructive Surgery Highlights article reviews 10 of the most notable Plastic Surgery Focus articles from 2024. While all of the articles from 2024’s section offered important contributions, several were distinguished by their topic, design, and conclusions, providing pivotal information on certain themes, including technology, business, and practice management; health care policy and outcomes; and pharmacotherapeutics in plastic surgery. TECHNOLOGY Artificial Intelligence Technology and its rapid evolution were a pervasive theme throughout 2024, and plastic surgery was no exception. Most noteworthy was the increase in utilization of different artificial intelligence (AI) platforms to improve on the delivery of health care. The Plastic Surgery Focus article from TerKonda et al. describes the important groundwork and future of AI in plastic surgery.1 The authors provide an in-depth review of critical concepts in AI, including the contributions of machine learning and, subsequently, deep learning, as well as the importance of big data in these systems. The study highlights several areas of current and potential future utilization of AI in plastic surgery, including assessment of burn depth,2 detection of vascular compromise,3 screening and classification of craniofacial anomalies,4 and analysis of beauty measures in aesthetic surgery.5 Augmented Reality Augmented reality (AR) platforms are increasingly being used in plastic surgery as an evolution of imaging-guided and virtual surgical planning. The study on spatial fidelity of AR by Cholok et al. provides an important “next step” in the integration of these platforms into the clinical setting.6 In its comparison of computed tomography-based, three-dimensionally printed models of deep inferior epigastric perforator anatomy to the same anatomy projected through a head-mounted wearable AR device, the study notably showed minor variations in translational displacement between the 2 modalities. In addition, it demonstrated the persistent limitations of holographic projections, including variability based on participant interpretation and vantage point, highlighting areas of further improvement for clinical translation of this technology. Social Media Social media continue to play a significant role in patient interactions that is pervasive throughout all plastic surgery subspecialties. A population-based survey study by Elmer et al. identified that the 3 most important factors for respondents in choosing a plastic surgeon were the surgeon’s experience with the desired procedure, board certification, and years in practice.7 The number of social media posts ranked among the 3 least important factors. Notable aspects of this study include the large survey sample size (369 respondents) and the subgroup analysis on age and income. Overall, the findings provide useful information that reinforces the importance of a surgeon’s reputation, experience, and training in surgeon selection, particularly in the age of social media marketing. BUSINESS AND PRACTICE MANAGEMENT A timely study Stoffel et al. analyzed trends in Medicare reimbursement of plastic surgery procedures in comparison with inflation.8 The results of the study are pertinent for all practicing plastic surgeons, as the authors demonstrated a mean inflation-adjusted growth in reimbursement of −13.5%, with the largest decrease in growth rate seen in microsurgery (−19.3%), followed by craniofacial surgery (−17.6%). A devaluation of effort in plastic surgery has several negative implications for government-reimbursed patient care, and reinforces the need for further advocacy and reimburse rate negotiation among all subspecialties. HEALTH CARE POLICY AND OUTCOMES One means of incentivizing high-quality care and preventing payment reductions from Medicare has been the Merit-based Incentive Payment System (MIPS). Implemented in 2017, MIPS offers performance-based payment adjustment of Medicare reimbursements, but plastic surgery performance in MIPS has not been well studied. Perez Otero et al. conducted the first analysis of MIPS performance among plastic surgeons and found that total performance, promoting interoperability, and improvement activities increased between 2019 and 2021, whereas quality scores decreased.9 Additional important findings included the correlation between larger practices as a significant predictor of receiving bonus payments and the concern of potential bias against socially disadvantaged patient populations. One clinical focus of plastic surgery that has fallen behind the current landscape of reimbursement and coding is lymphatic surgery. In a health policy special topic article from 2024, Rochlin et al. investigated variation in commercial payor rates for the many Current Procedural Terminology codes used in physiologic and reductive lymphedema surgery procedures, including lymphovenous bypass, vascularized lymph node transplants, suction lipectomy, and direct excision.10 They identified significant variability both within and across hospital systems in negotiated rates, as well as relative undervaluation of physiologic procedures compared with excisional ones. This study reinforces the need for the development of standardized coding for lymphedema surgery. National health care outcomes were the focus of an important study on gender-affirming surgery by Kilmer et al.11 The authors propensity score–matched 3134 gender-dysphoric patients who underwent surgery with a control group based on data from a national insurance claims–based database. They found that those who underwent surgery had decreased postoperative rates of antidepressant use, as well as improved mental health indices. The study provides important evidence on the mental health benefits of gender-affirming surgery for the gender-dysphoric population in appropriately selected patients. EDUCATION Plastic surgery training has evolved to encompass not only traditional core components of plastic surgery but also more comprehensive aspects of modern health care practice. Along these lines, how well are plastic surgery trainees readied for the “real world”? The article by Krasniak et al. analyzed a critical component of this, financial literacy, through a survey study of 112 plastic surgery trainees in U.S. residency programs.12 The authors identified that 1 in 5 trainees did not feel prepared to manage finances after graduation, and the majority had received no finance education during training. The study highlights the important need to bolster financial literacy curricula in residency programs as a means improving wellness and decreasing burnout in future practicing plastic surgeons. PHARMACOTHERAPEUTICS A wealth of research has been dedicated to assessing venous thromboembolism risk and minimizing the occurrence of venous thromboembolism after plastic surgery procedures. The 2024 Plastic Surgery Focus review article by Othman et al. comprehensively and succinctly describes the pharmacology, dosing, indications, advantages, and disadvantages of different chemoprophylaxis agents, including unfractionated heparin, low-molecular-weight heparin, and indirect factor Xa inhibitors.13 Important recommendations based on randomized controlled trials and meta-analyses of randomized controlled trials are provided, particularly regarding the use of enoxaparin prophylaxis for high-risk inpatients with a Caprini score of 7 or greater,14 as well as the need for additional high-level-of-evidence data on oral Xa inhibitor prophylaxis for plastic surgery patients. Tranexamic acid (TXA) is another important pharmacologic agent that has been increasingly utilized in plastic surgery as a means of reducing surgical blood loss. Brown et al. performed a systematic review and meta-analysis of 45 studies on the use of TXA in plastic surgery procedures.15 The authors identified high-certainty evidence for the use of TXA in cosmetic surgery, particularly rhinoplasty, to reduce blood loss and moderate-certainty evidence for blood loss reduction in craniofacial and burn surgery. On the other hand, evidence was lacking for improved outcomes in breast surgery, face lift procedures, and microsurgery. The study provides important clinical recommendations for TXA use and highlights areas in need of further research. CONCLUSIONS This collection of Plastic Surgery Focus articles from 2024 covers many important areas in the modern practice of plastic surgery. Notable topics include the increased utilization of AI and AR in plastic surgery, the role of social media in patient interactions, procedural reimbursement trends and incentive programs, gender-affirming surgery outcomes, financial preparation of trainees, and important pharmacologic agents within plastic surgery. Overall, these articles describe important advances in knowledge, review essential topics for the practicing plastic surgeon today, and define many of the future directions of the field. DISCLOSURE Dr. Salibian is a research consultant for AbbVie, Inc.

  PublisherDOI

• Staged Breast Reduction or Mastopexy before Nipple-Sparing Mastectomy: A Systematic Review and Meta-Analysis

  Plastic & Reconstructive Surgery · 2025-03-25 · 5 citations

  reviewSenior author

  BACKGROUND: Macromastia and breast ptosis have traditionally been considered to be relative contraindications to nipple-sparing mastectomy (NSM) because of concerns regarding nipple and mastectomy flap viability. Staged breast reduction or mastopexy before NSM has demonstrated promising results in decreasing these complications, although data are limited to single-center studies with small sample sizes. METHODS: A systematic review of PubMed, Scopus, and Cochrane databases was performed to identify all studies analyzing reconstructive outcomes in patients who underwent staged breast reduction or mastopexy before NSM. Descriptive analyses of surgical techniques and reconstructive outcomes were performed for relevant articles included for analysis. Random-effects model meta-analysis was performed to assess complication rates. RESULTS: Eleven studies, with a pooled total of 542 breasts (288 patients), were identified for analysis. The majority of mastectomies were performed prophylactically (79.2%). Staged breast reduction was performed in 75.2% of patients, and mastopexy was performed in 24.5%. The mean reduction weight per breast was 354.4 ± 64.0 g, and the mean mastectomy specimen weight was 527.5 ± 207.9 g. Autologous techniques were used for reconstruction in 39.7% of breasts, 59.6% had implant-based reconstruction, and 0.7% of cases had hybrid reconstruction. Meta-analysis demonstrated low rates of complications in patients who underwent staged NSM, including nipple-areola complex necrosis (3.1%; 95% CI, 0.8% to 6.3%) and mastectomy flap necrosis (2.4%; 95% CI, 0.1% to 6.3%). CONCLUSIONS: Systematic review and meta-analysis of outcomes for staged breast reduction or mastopexy demonstrate low rates of nipple and mastectomy flap necrosis. These data suggest thaprophylactic optimization of breast morphology can improve outcomes and expand candidacy for nipple-sparing procedures.

  PublisherDOI

• Pushing the DIEP Envelope: Where Are We Now?

  Journal of Clinical Medicine · 2025-09-04 · 2 citations

  reviewOpen accessSenior authorCorresponding

  The deep inferior epigastric perforator (DIEP) flap in breast reconstruction has been an evolution in providing an ideal autologous reconstruction while minimizing donor site morbidity. Innovations have continued to optimize the DIEP flap in multiple facets. Alternative flap designs, vasculature modifications, and conjoined and stacked flaps have improved the ability to increase flap volume and perfusion. Advancements in anatomic understanding of the abdomen have resulted in decreases in donor site morbidity and improved abdominal outcomes. Patient satisfaction regarding aesthetics has been enhanced through careful consideration of mastectomy techniques and recipient site modifications in addition to improved quality of life outcomes through sensory innervation. The study reviews the evolution and current state of abdominally-based breast reconstruction in its goal of optimizing aesthetic, patient-reported and quality-of-life outcomes while minimizing complications.

  PublisherOA PDFDOI

• Pushing the DIEP Envelope: Where are we Now?

  Preprints.org · 2025-07-30

  preprintOpen accessSenior author

  The deep inferior epigastric perforator (DIEP) flap in breast reconstruction has been an evolution in providing an ideal autologous reconstruction while minimizing donor site morbidity. Innovations have continued to optimize the DIEP flap in multiple facets. Alternative flap designs, vasculature modifications, and conjoined and stacked flaps have improved the ability to increase flap volume and perfusion. Advancements in anatomic understanding of the abdomen have resulted in decreases in donor site morbidity and improved abdominal outcomes. Patient satisfaction regarding aesthetics has been enhanced through careful consideration of mastectomy techniques and recipient site modifications in addition to improved quality of life outcomes through sensory innervation. The study reviews the evolution and current state of abdominally-based breast reconstruction in its goal of optimizing aesthetic, patient-reported and quality-of-life outcomes while minimizing complications.

  PublisherOA PDFDOI

• Optimizing perfusion and volume in autologous breast reconstruction: dual-plane, conjoined and stacked flaps

  Plastic and Aesthetic Research · 2024-07-31 · 1 citations

  articleOpen accessSenior authorCorresponding

  Microsurgical breast reconstruction has continued to evolve to improve outcomes and minimize complications. Dual-plane, conjoined and stacked flaps represent one aspect of this evolution in an effort to improve tissue perfusion and flap volume. Dual-plane flaps combine the superficial and deep circulation in abdominally-based free flaps to augment perfusion. Conjoined flaps use additional pedicles to supply multiple perforasomes combined in a single flap. Stacked flaps utilize separate flaps on individual pedicles to increase volume at a single recipient site. Multiple donor sites, pedicle configurations and recipient vessel choices have been described, primarily focusing on using the cranial and caudal internal mammary system as well as intra-flap anastomoses. Though more technically demanding, dual-plane, stacked and conjoined flaps allow for improvement in flap perfusion and volume, and are important tools for optimizing results in autologous breast reconstruction.

  PublisherOA PDFDOI

• Ultrasound in Microsurgery: Current Applications and New Frontiers

  Journal of Clinical Medicine · 2024-06-11 · 16 citations

  articleOpen accessSenior authorCorresponding

  Ultrasound has revolutionized reconstructive microsurgery, offering real-time imaging and enhanced precision allowing for preoperative flap planning, recipient vessel identification and selection, postoperative flap monitoring, and lymphatic surgery. This narrative review of the literature provides an updated evidence-based overlook on the current applications and emerging frontiers of ultrasound in microsurgery, focusing on free tissue transfer and lymphatic surgery. Color duplex ultrasound (CDU) plays a pivotal role in preoperative flap planning and design, providing real-time imaging that enables detailed perforator mapping, perforator suitability assessment, blood flow velocity measurement, and, ultimately, flap design optimization. Ultrasound also aids in recipient vessel selection by providing assessment of caliber, patency, location, and flow velocity of recipient vessels. Postoperatively, ultrasound enables real-time monitoring of flap perfusion, providing early detection of potential flap compromise and improved flap survival rates. In lymphatic surgery, ultra-high frequency ultrasound (UHFUS) offers precise mapping and evaluation of lymphatic vessels, improving efficacy and efficiency by targeting larger dilated vessels. Integrating ultrasound into reconstructive microsurgery represents a significant advancement in the utilization of imaging in the field. With growing accessibility of devices, improved training, and technological advancements, using ultrasound as a key imaging tool offers substantial potential for the evolution of reconstructive microsurgery.

  PublisherOA PDFDOI

• Prepectoral versus Subpectoral Breast Reconstruction after Nipple-sparing Mastectomy: A Systematic Review and Meta-Analysis

  Plastic & Reconstructive Surgery Global Open · 2024-05-01 · 14 citations

  reviewOpen accessSenior author

  Background: Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total submuscular (TSM), dual-plane (DP), and prepectoral (PP) planes; however, a dedicated meta-analysis relevant to NSM is lacking. Methods: We conducted a systematic review of studies on immediate breast reconstruction after NSM using TSM, DP, or PP prosthesis placement in PubMed, Embase, and Cochrane databases. In total, 1317 unique articles were identified, of which 49 were included in the systematic review and six met inclusion criteria for meta-analysis. Pooled descriptive outcomes were analyzed for each cohort for all 49 studies. Fixed-effects meta-analytic methods were used to compare PP with subpectoral (TSM and DP) reconstructions. Results: A total of 1432 TSM, 1546 DP, and 1668 PP reconstructions were identified for descriptive analysis. Demographics were similar between cohorts. Pooled descriptive outcomes demonstrated overall similar rates of reconstructive failure (3.3%-5.1%) as well as capsular contracture (0%-3.9%) among cohorts. Fixed-effects meta-analysis of six comparative studies demonstrated a significantly lower rate of mastectomy flap necrosis in the PP cohort compared with the subpectoral cohort (relative risk 0.24, 95% confidence interval [0.08-0.74]). All other consistently reported outcomes, including, hematoma, seroma, infection, mastectomy flap necrosis, nipple -areola complex necrosis, and explantation were comparable. Conclusions: A systematic review of the literature and meta-analysis demonstrated the safety of immediate prepectoral breast reconstruction after NSM, compared with submuscular techniques. Submuscular reconstruction had a higher risk of mastectomy flap necrosis, though potentially influenced by selection bias.

  PublisherDOI

Frequent coauthors

• Nolan S. Karp

  NYU Langone Health

  121 shared

• Mihye Choi

  109 shared

• Jordan D. Frey

  University at Buffalo, State University of New York

  87 shared

• Jonathan M. Bekisz

  NYU Langone Health

  58 shared

• Vishal Thanik

  NYU Langone Health

  33 shared

• Rachel Bluebond‐Langner

  NYU Langone Health

  31 shared

• Jamie P. Levine

  New York University

  29 shared

• Carter J. Boyd

  NYU Langone Health

  25 shared

Labs

• Center for Lymphatic DiseasePI

Awards & honors

• Awards for Publishing Excellence (APEX), Award of Excellence…
• Best Resident Clinical Presentation, Northeastern Society of…
• John Bostwick Paper Award Winner, Atlanta Breast Symposium (…
• Best Resident Clinical Presentation - Northeastern Society o…
• Alpha Omega Alpha Honor Medical Society (2013)