Publications

The purpose of this study was to evaluate epidemiologic characteristics and postoperative complications among nonbinary, transgender, and cisgender adults undergoing mastectomy or breast augmentation. Comparable postoperative complication rates were observed between gender modality cohorts undergoing breast augmentation, but higher complication rates were observed among cisgender patients following mastectomy, likely due to variations in clinical indications and technique. These results underscore the safety of chest surgery for gender-diverse patients.

BACKGROUND: Capsular contracture is a leading cause of morbidity after breast augmentation and often necessitates reoperation. This study analyzes the association between breast capsule thickness and severity of capsular contracture, distinguishing benign from pathological cases.

METHODS: Literature review was conducted across PubMed, Medline, and Web of Science according to PRISMA guidelines, for articles published between 2014 and 2024. Data extracted included author, year, sample size, age, implant type, capsule thickness, capsular contracture presence, and Baker score. A permutation test determined a minimum thickness cutoff associated with capsular contracture. Statistical meta-analysis, permutation analysis, and univariate Poisson regression were conducted using R 4.4.1 (Boston, MA).

RESULTS: Of 649 publications, 12 met inclusion criteria, examining 590 breast samples from 403 patients. The mean capsular thickness was 708 µm. The capsular contracture rate was 47.6% of breasts and in 69.7% of patients. Meta-regression of 534 samples across nine studies including 25 unique patient groupings showed a pooled capsular contracture rate in breasts of 58.2% (95% CI: 28.2-83.1). Capsular thicknesses in the highest (OR 23.99, 95% CI: 13.31-45.10, p < 0.001) and middle (OR 16.22, 95% CI: 9.95-27.16, p < 0.001) tertiles had higher odds of contracture compared to the lowest tertile. Univariate Poisson regression showed a 0.069% (95% CI: 0.050-0.087, p < 0.001) increase in contracture per micrometer of capsule thickness. The minimum significant cutoff was 601.5 µm (p < 0.05), below which studies had significantly lower capsular contracture rates.

CONCLUSIONS: Capsule thickness correlates with capsular contracture, suggesting a measurable predictor for pathological contracture.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Background: Limited evidence exists regarding the incidence of revision cosmetic rhinoplasty in patients with psychiatric diagnoses. Objective: To assess the rate of revision cosmetic rhinoplasty in patients with psychiatric diagnoses. Methods: Adult patients at a single institution who underwent rhinoplasty were queried between December 1, 1979, and June 1, 2024. Exclusion criteria were noncosmetic rhinoplasties (e.g., functional) or history of nasal trauma, nasal tumor, cleft lip/palate, or congenital nasal deformities. Patients were split into those with psychiatric diagnoses (PD group) and those without (control group). Outcomes include proportion who underwent ≥1 secondary cosmetic rhinoplasty, mean secondary rhinoplasties per patient, patient satisfaction after secondary rhinoplasty, and breakdown of secondary rhinoplasties by psychiatric diagnosis. Results: The initial query found 1110 patients, leaving 961 patients (PD 135, control 826) after exclusion criteria. The cohort was 75% female (724/961) with a mean age of 48 years (standard deviation: 15). The proportion of patients with ≥1 revision rhinoplasty was higher in PD (24/135, 18%) than controls (95/826, 12%; p = 0.04). Age ≥46 and female gender were found to predict revision cosmetic rhinoplasty. Conclusion: In our cohort, patients with PD had higher rates of revision cosmetic rhinoplasty compared to those without PD.

BACKGROUND: Lighting conditions for photographic documentation during pre- and postoperative visits are critical in capturing the outcomes of rhinoplasty for patients. Current standards may not provide direct side lighting, which can enhance visualization of uneven textures. We present a revised studio setup with dual-function background lights positioned perpendicular to the subject-camera axis to provide both back and side lighting.

METHODS: Rhinoplasty pictures were taken in an academic hospital clinic office from six standard angles for pre- and postoperative photography. Two foreground LED continuous lights were placed at 45 degrees relative to the subject-camera axis. An additional two LED continuous lights were angled perpendicularly to the subject-camera axis and positioned at approximately half the distance between the subject and background. Rapid colorimetric image analysis was conducted, and Hex color values were compared to a reference photograph to evaluate colorimetric distortion [4]. Paired images were evaluated by four blinded providers to evaluate nasal structure distortion, image sharpness, image noise, and overall clinical fidelity.

RESULTS: Color accuracy was maintained for the four-light and two-light conditions in the frontal view, with 97% and 94% fidelity compared to the true reference, respectively. In the right oblique view, fidelity for the four-light system was 99% as compared to 100% for the two-light system. Subjective provider ratings established the proposed lighting system as superior in terms of overall clinical fidelity to the standard two-light conditions in nearly all angles (87.5%).

CONCLUSION: This study focuses on moving beyond primarily two foreground lighting which may be limited in terms of side-lighting effects and resultant impact on overall image quality in the goals of optimizing pre- and post-operative documentation.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

OBJECTIVE: An increasing number of women are choosing careers in the field of plastic and reconstructive surgery (PRS). These evolving surgeon demographics have highlighted the need for parental leave policies, lactation accommodations, and childcare services. Therefore, this study examines the reproductive and childbearing challenges that plastic and reconstructive surgeons encounter. Specific areas of focus include obstetric complications, parental leave, breastfeeding, childcare, and infertility.

METHODS: In September 2024, a scoping review was conducted across CINAHL, Google Scholar, MEDLINE, PubMed, and Scopus, following PRISMA-ScR guidelines. Randomized control trials, observational studies, surveys, and interviews that examined pregnancy, parental leave, or family planning in PRS trainees or attendings were included. Abstracts, commentaries, editorials, systematic reviews, and non-English studies were excluded.

RESULTS: Seventeen studies, consisting primarily of surgeon experience surveys (82.35%, n = 3,145), were examined. Infertility affected 19.6%-50.7% of surgeons, with 9.8%-19.6% utilizing assisted reproductive technology. Female surgeons were older at their first live births than the general population and faced stigma related to pregnancy. Between 39% and 56% experienced obstetric complications. Many reported a lack of lactation spaces and greater childcare burdens. Following the institution of a policy protecting parental leave by the American Board of Plastic Surgery (ABPS), trainees reported a positive affirmation in their selection of the surgical specialty.

CONCLUSIONS: The implementation of protected parental leave has positively influenced workplace culture in PRS. However, significant gender-related challenges remain, particularly stigmas surrounding pregnancy and parental leave.

PURPOSE: A recent TikTok trend of users reporting nasal size reduction after oral isotretinoin has conflated this acne medication as a nonsurgical rhinoplasty option, termed "Accutane rhinoplasty". We conducted a systematic review of studies reporting outcomes of rhinoplasty and oral isotretinoin and analyzed TikTok reels published under this emerging aesthetic trend.

METHODS: A comprehensive systematic literature search was conducted in December 2024 using the MEDLINE, Web of Science, and EMBASE databases following PRISMA guidelines. Studies reporting outcomes of rhinoplasty patients treated with oral isotretinoin were included. TikTok Scraper extracted details of English-language TikTok reels posted up to September 2024 under three hashtags: #accutanenosejob, #accutanenose, and #accutanenosejobcheck.

RESULTS: Five articles met inclusion criteria. Studies included a median of 24 patients, with isotretinoin administered postoperatively in all studies and preoperatively in two studies. Two of three prospective studies reported positive findings, including lower frequency of facial acne, reduced facial skin thickness, and higher patient satisfaction. Retrospective studies reported mixed findings, including improved nasal skin appearance, increased rhinoplasty complications, and isotretinoin side effects. TikTok hashtags have 68.5 million views, and 100 reels were included for review. Self-reported physicians represented 10% (10/100) of reels and self-reported patients reporting nasal size reduction after isotretinoin represented 90% (90/100) of reels.

CONCLUSIONS: Current evidence on isotretinoin use in rhinoplasty patients is limited, with small sample sizes and mixed findings. While some studies suggest potential benefits in patients with thick nasal skin or severe acne, the long-term effects and safety profile remain unclear. The popularity of "Accutane rhinoplasty" on TikTok contrasts with the scarcity of rigorous clinical data, underscoring the need for further high-quality studies and greater clinician engagement in online discussions.

LEVEL OF EVIDENCE II: Therapeutic study. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: Patients with breast cancer living in rural areas are less likely to undergo breast reconstruction. Further, given the additional training and resources required for autologous reconstruction, it is likely that rural patients face barriers to accessing these surgical options. Therefore, the purpose of this study is to determine if there are disparities in autologous breast reconstruction care among rural patients on the national level.

METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database was queried from 2012 to 2019 using ICD9/10 codes for breast cancer diagnoses and autologous breast reconstruction. The resulting data set was analyzed for patient, hospital, and complication-specific information with counties comprised of less than 10,000 inhabitants classified as rural.

RESULTS: From 2012 to 2019, 89,700 weighted encounters for autologous breast reconstruction involved patients who lived in non-rural areas, while 3605 involved patients from rural counties. The majority of rural patients underwent reconstruction at urban teaching hospitals. However, rural patients were more likely than non-rural patients to have their surgery at a rural hospital (6.8% vs. 0.7%). Rural-county residing patients had lower odds of receiving a deep inferior epigastric perforator (DIEP) flap compared to non-rural-county residing patients (OR 0.51 CI: 0.48-0.55, p < .0001). Further, rural patients were more likely to experience infection and wound disruption than urban patients (p < .05), regardless of where they underwent surgery. Complication rates were similar among rural patients who received care at rural hospitals versus urban hospitals (p > .05). Meanwhile, the cost of autologous breast reconstruction was higher (p = .011) for rural patients at an urban hospital ($30,066.2, SD19,965.5) than at a rural hospital ($25,049.5, SD12,397.2).

CONCLUSION: Patients living in rural areas face disparities in health care, including lower odds of being potentially offered gold-standard breast reconstruction treatments. Increased microsurgical option availability and patient education in rural areas may help alleviate current disparities in breast reconstruction.

BACKGROUND: Gluteal augmentation with autologous fat grafting, colloquially referred to as Brazilian butt lift (BBL), is an increasingly common procedure with a highly reported complication profile.

OBJECTIVES: In this study we aimed to analyze the prevalence and characteristics of complications that accompanied these surgeries at ambulatory surgery facilities.

METHODS: Adults patients who experienced fat grafting complications from 2019 to 2021 were identified in QUAD A, formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, Highland Park, IL, USA), database. Patients and complications were analyzed based on sociodemographic, surgery-, and facility-specific variables with descriptive statistics and logistic regression.

RESULTS: Overall, 436 fat grafting procedures with complications were reported to QUAD A, with an overall complication rate of 0.94%. Of these complications, 164 (37.6%) were confirmed to be from gluteal augmentation procedures. Notably, the number of gluteal augmentation with fat grafting complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%), with a mean age of 42.0 years and a mean BMI of 28.3 kg/m2. Wound infection was the most commonly documented complication (22.3%). Of the patients who experienced complications, 35.9% presented to a hospital for their complications and 12.6% required reoperation. Four deaths were described. There was no association between sociodemographic or surgical variables and increased odds of readmission or reoperation (P > .05), except for increasing surgeon number and reoperation (P = .02).

CONCLUSIONS: Gluteal augmentation accounts for a large proportion of complications from fat grafting procedures. Increased reporting requirements may aid in future determination of incidences of complications and improve patient safety.