Systematic Review of Poly-4-Hydroxybutyrate in Modern Breast Surgery.

Several biologic and synthetic adjuncts have been employed to reduce ptosis and improve cosmesis in breast surgery. Poly-4-hydroxybutyrate (P4HB), a fully absorbable polymer, continues to increase in use. This study sought to identify uses of P4HB in both reconstructive and aesthetic breast surgery and synthesize the available data on its outcomes and efficacy.

Techniques for Success in Nipple-Sparing Mastectomy and Immediate Reconstruction.

Nipple-sparing mastectomy (NSM), given demonstrated oncologic safety, is widely used for both therapeutic and prophylactic mastectomy. The popularity of NSM has spurred advancements by breast and plastic surgeons, liberalizing the indications for NSM and improving patient and aesthetic reconstructive outcomes. This review explores these developments and establishes up-to-date surgical tenets for successful NSM and reconstruction.

Is a Seroma the "Kiss of Death" in Prepectoral Tissue Expander Reconstruction?

Background: A seroma following prepectoral tissue expander (TE) reconstruction often begets other complications, which may compromise the reconstruction. This study investigated the association between seroma and subsequent complications.

Methods: All consecutive prepectoral TE reconstructions performed between March 2017 and December 2022 at a single center were reviewed.

Quantifying the Learning Curve in Robotic Peritoneal Flap Vaginoplasty.

Background: The learning curve (LC) is the process of mastering a new technique. This study assesses the LC for robotic-assisted peritoneal flap gender-affirming vaginoplasty (RPGAV).

Methods: A retrospective chart review of all consecutive patients undergoing RPGAV between 09/2017 and 02/2023 at a single center was performed.

Finding the Right Fill: The Ideal Tissue Expander Fill in Immediate Prepectoral Breast Reconstruction.

Purpose: Although many factors in prepectoral breast reconstruction such as mastectomy weight and flap quality are out of the plastic surgeon's control, some elements such as intraoperative tissue expander (TE) fill can be optimized. This study assesses the impact of intraoperative TE fill on postoperative complications in prepectoral breast reconstruction and posits the optimal fill.

Methods: All consecutive, prepectoral TE reconstructions performed between March 2017 and December 2022 at a single center were reviewed.

Assessing Perioperative Complications and Cost of Nipple-Areolar Complex Neurotization in Immediate Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Matched-Paired Comparison.

Background: Reports suggest neurotization can help restore sensation in patients undergoing implant-based breast reconstruction (IBBR) following nipple-sparing mastectomy (NSM). There is a dearth of information regarding the outcomes and cost associated with neurotization of the nipple-areola complex (NAC). The objective of this study is to determine perioperative complications of performing NAC neurotization in IBBR and analyze the added cost of performing this procedure.

"Gender-Affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long Term Outcomes of 500 Cases".

Objective: The objective of this study was to determine the outcomes of robotic peritoneal flap vaginoplasty.

Background: There is a lack of long-term outcomes data for gender-affirming vaginoplasty to inform patient decision-making.

Methods: A retrospective cohort of 500 consecutive patients undergoing robotic peritoneal flap vaginoplasty from 2017-2023 were reviewed.

The Evolution of Implant-Based Breast Reconstruction: Innovations, Trends, and Future Directions.

Implant-based breast reconstruction has been essential since the 1960s, offering a faster and less invasive alternative to autologous reconstruction. Recent innovations-including direct-to-implant (DTI) reconstruction, advancements in surgical planes, synthetic meshes, and nipple-areolar complex (NAC) neurotization-have improved patient outcomes. This review explores these developments, analyzing their impact on breast reconstruction over the past two decades.

Diversity in the US Academic Microsurgery Pathway.

Although the representation of women and ethnic minority students in the US medical schools has recently increased, discrepancies in representation among plastic surgery residents and faculty continue. The state of sex and ethnic diversity in academic microsurgery remains minimally investigated. We aimed to evaluate the sex, race, and ethnicity demographics among academic microsurgeons and identify underrepresentation along the leadership pathway.

The GalaFLEX "Empanada" for Direct-to-Implant Prepectoral Breast Reconstruction.

Prepectoral breast reconstruction poses unique challenges, including a lower tolerance for mastectomy flap skin necrosis and seroma formation. With appropriate patient selection, prepectoral breast reconstruction is a valuable reconstructive option with numerous benefits. Although mastectomy skin necrosis is largely out of the control of the reconstructive surgeon, mitigation of seroma formation is critical.

AXIN1 mutations in nonsyndromic craniosynostosis.

Objective: Occurring once in every 2000 live births, craniosynostosis (CS) is the most frequent cranial birth defect. Although the genetic etiologies of syndromic CS cases are well defined, the genetic cause of most nonsyndromic cases remains unknown.

Methods: The authors analyzed exome or RNA sequencing data from 876 children with nonsyndromic CS, including 291 case-parent trios and 585 additional probands.

Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature.

Background: Breast implant illness (BII) has become a contentious subject in recent years. Although some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link.

Objectives: The objective of this study was to provide a comprehensive, up-to-date evaluation of the literature surrounding BII, with an emphasis on identifying patient-related factors that may be associated with BII.

Merit-Based Incentive Payment System: How Are Plastic Surgeons Performing?

Background: The Merit-based Incentive Payment System (MIPS) is a payment model implemented to promote high-value care through performance-based adjustments of Medicare reimbursements. Higher scores indicate superior performance in health care quality, efficiency, and interoperability, which can result in financial advantages. Given the paucity of literature, the authors aimed to characterize plastic surgery performance in MIPS.

The Evolving Plastic Surgery Applicant: How Far Have We Come in 30 Years?

Background: Plastic surgery training has undergone tremendous change and transitioned through many models over the years, including independent, combined, and integrated. This study evaluates how these changes and others have affected plastic surgery applicants' demographics and academic qualifications over the last 30 years.

Methods: Data on applicant demographics and academic qualifications were extracted from multiple sources including the National Resident Matching Program, the American Association of Medical Colleges, and cross-sectional surveys of plastic surgery applicants for the years 1992, 2005, 2011, and 2022.

Minimizing Nipple-Areolar Complex Complications in Prepectoral Breast Reconstruction After Nipple-Sparing Mastectomy.

Purpose: Nipple-areolar complex (NAC) viability remains a significant concern following prepectoral tissue expander (TE) reconstruction after nipple-sparing mastectomy (NSM). This study assesses the impact of intraoperative TE fill on NAC necrosis and identifies strategies for mitigating this risk.

Methods: A chart review of all consecutive, prepectoral TEs placed immediately after NSM was performed between March 2017 and December 2022 at a single center.

Differential preferences in breast aesthetics by self-identified demographics assessed on a national survey.

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon's practice presenting for breast surgery was assembled.

Artificial Intelligence as a Triage Tool during the Perioperative Period: Pilot Study of Accuracy and Accessibility for Clinical Application.

Background: Given the dialogistic properties of ChatGPT, we hypothesized that this artificial intelligence (AI) function can be used as a self-service tool where clinical questions can be directly answered by AI. Our objective was to assess the content, accuracy, and accessibility of AI-generated content regarding common perioperative questions for reduction mammaplasty.

Methods: ChatGPT (OpenAI, February Version, San Francisco, Calif.

Preauthorization Inconsistencies Prevail in Reduction Mammaplasty.

Background: Despite evidence documenting the physical and psychological benefits of breast reduction, third-party payer approval remains a cumbersome process. The objective of this study was to assess differences in medical necessity criteria for reduction mammaplasty among US insurance carriers while analyzing trends in claim denials and appeals.

Methods: The medical necessity criteria for reduction mammaplasty were retrieved from seven large health insurance carriers.

Global Prevalence and Burden of Orofacial Clefts: A Systematic Analysis for the Global Burden of Disease Study 2019.

Orofacial clefts, in particular cleft lip and cleft palate, are among the most common congenital anomalies. Despite guidelines recommending early surgical correction, a global backlog of untreated patients persists. This has made orofacial clefts an attractive target for global cleft care initiatives.

No Cancer Occurrences in 10-year Follow-up after Prophylactic Nipple-sparing Mastectomy.

Unlabelled: Prophylactic nipple-sparing mastectomies (NSM) have become increasingly common, although there is little long-term data on its efficacy in prevention of breast cancer. The objective of this study was to assess the incidence of breast cancer in a cohort of patients undergoing prophylactic NSM with a median follow-up of 10 years.

Methods: Patients receiving prophylactic NSM at a single institution from 2006 to 2019 were included in a retrospective nature.

Maximizing volume in autologous breast reconstruction: stacked/conjoined free flaps.

Since the first report of abdominally based tissue breast reconstruction with a free flap of rectus abdominis muscle to reconstruct mastectomy defects, autologous breast reconstruction has continually increased in popularity due to improved cosmesis, patient satisfaction, and quality of life. While abdominal tissue is frequently used as the principal donor site, other flap options are available, including from the buttocks, thighs, and back. Microsurgical advancements in recent years have continued to improve patient outcomes and decrease operative times.

Fertility and Childbearing Outcomes of Practicing Female Plastic Surgeons.

Background: Women now represent approximately one-third of plastic surgery residents. The impact of a career in plastic surgery on family planning is unknown. The aim of this study was to report the current status of fertility and childbearing outcomes of practicing female plastic surgeons.

Evolution in Parental Leave Policies: Plastic Surgery and Obstetrics/Gynecology Lead the Way.

Background: Forty percent of physicians anticipate becoming parents during residency. This often occurs in the absence of clear parental leave and breastfeeding policies, which may adversely impact parental and child health or jeopardize residents' board eligibility, fellowship, and job prospects. This study reports on the current status of parental leave and breastfeeding policies across all specialties.

Breast reconstruction during the COVID-19 pandemic: Single institution experience from the pandemic's epicenter in the United States.

Introduction: The coronavirus disease-19 (COVID-19) pandemic dramatically changed the delivery of breast cancer care. The objective of this study was to quantify the effect of the pandemic on breast cancer screening, treatment, and reconstruction at a single institution in New York City.

Methods: A retrospective chart review was conducted to determine the number of mammograms, lumpectomies, mastectomies, and breast reconstruction operations performed between January 1, 2019 and June 30, 2021.