Publications

BACKGROUND: Reduction mammaplasty can provide symptomatic relief to patients suffering from macromastia; however, complications such as dehiscence are common. It is unknown if the presence of complications affects patient-reported outcomes.

OBJECTIVES: The aim of this study was to determine the risk factors for the development of complications, and to examine the correlation between postoperative complications and patient-reported outcomes in reduction mammaplasty.

METHODS: A single-center retrospective chart review was undertaken of patients who received reduction mammaplasties (CPT 19318), performed by 13 surgeons, between January 2017 and February 2023. Breast cancer cases and oncoplastic reconstructions were excluded. Patients with >1 complication were grouped into the complications cohort. Satisfaction was assessed by administering the BREAST-Q survey.

RESULTS: A total of 661 patients were included for analysis, 131 of whom developed at least 1 complication. Patients in the group with complications had significantly higher average ages and BMIs, and a higher likelihood of hypertension and diabetes (P < .01). Among 180 BREAST-Q responders, 41 had at least 1 complication. There were no significant differences between the 2 groups (complications vs no complications) across survey outcomes. Although obese patients were more likely to develop infection and require revisions (P < .01), no significant differences in subgroup analysis of patient-reported outcomes focusing on obese patients were observed.

CONCLUSIONS: Obesity, hypertension, and diabetes were associated with postoperative complications of reduction mammaplasty. Patients with complications had similar postoperative BREAST-Q satisfaction to patients without complications. Although risk optimization is critical, patients and surgeons should be reassured that satisfaction may be achieved even in the event of a complication.

BACKGROUND: Suction lipectomy (liposuction) is a popular cosmetic surgical procedure performed in the United States, but little has been documented regarding perioperative complications due to its outpatient nature.

OBJECTIVES: This cross-sectional study aims to analyze the most common complications that accompany liposuction-related procedures and importantly estimate the total complication rate occurring at ambulatory surgical facilities.

METHODS: Adult patients who experienced liposuction-related complications from 2019 to 2021 were identified in the reporting database of the global surgery accreditation authority, the American Association for Accreditation of Ambulatory Surgery Facilities (QUAD A). Patients were then divided by complication type and procedure location. Demographics and facility-specific variables were analyzed. Descriptive statistics were performed.

RESULTS: Overall, 984 patients were included, with a mean age of 44 years (interquartile range [IQR] 37-53) and a median BMI of 28.7 kg/m2 (IQR 25.7-32.2). The overall confirmed complication rate was found to be 0.40% (984/246,119). Unplanned emergency department presentation was the most common complication overall (24%). Wound disruption was associated with the longest median procedure length (261 min), and venous thromboembolism was associated with the highest median BMI (30.1 kg/m2). The Southeast had the most complications (431), which accounted for 13/21 deaths (61.9%). Out of all complications, death was associated with the highest average annual case volume (241).

CONCLUSIONS: Procedures that involve liposuction are associated with a variety of medical and surgical complications. Given the high frequency and variability in how liposuction is performed, a thorough assessment of complications is critical to improve the safety of this procedure.

Background: Plastic surgery interest groups (PSIGs) provide an invaluable opportunity to enhance medical students' exposure to and knowledge of plastic surgery. Despite this, there have been no studies that provide information on the formation of these groups as well as the aspects that make for a productive PSIG. Methods: An anonymous survey was distributed by email via RedCAP to US medical students who hold leadership positions within their medical school's PSIG. Participants were asked baseline medical school information, the structure of their interest group, and perspectives on the most impactful and challenging components of their interest group. Results: Sixteen members (27.6%) of PSIG leadership completed the survey. Eighty percent reported having a membership of greater than 20 students. Fifty percent of the PSIGs were led by advisors who were medical school or hospital-affiliated faculty. Sixty-nine percent of groups were allocated a predetermined amount of money to fund activities and events throughout the academic year. Based on member feedback, groups reported that interactions with plastic surgery faculty, mentorship opportunities, and research opportunities were the most impactful and beneficial components of their PSIG. Forty-four percent reported that the biggest challenge faced by their PSIG was having a small active member group, followed by a lack of funding. Conclusion: Our study provides an in-depth look at the current structure and impact of PSIGs in the United States. It also provides a framework for medical schools that wish to start a PSIG and suggestions for established groups who wish to revitalize their PSIG structure.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities including hypertension, obesity, insulin resistance, and dyslipidemia. The safety profiles of patients with MetS undergoing breast reconstruction remain underreported. This study aims to evaluate the impact of MetS on the BR decision-making process and postoperative complication rates.

METHODS: The ACS-NSQIP database was utilized to identify women who underwent BR between 2012 and 2021. Baseline characteristics were compared based on the presence of MetS, defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m2. Group differences were assessed using t tests and Fisher's exact tests. Multivariate logistic regression models evaluated postoperative complications between the groups.

RESULTS: A total of 160,115 patients underwent BR. A total of 4570 had a diagnosis of MetS compared to 155,545 without MetS. No statistically significant differences were observed in the type of BR patients received across cohorts. Logistic regression models demonstrated a higher likelihood of postoperative wound complications (OR 2.21; 95% CI 1.399, 3.478; p = 0.001), and readmission rates (OR 2.045; 95% CI 1.337, 3.128; p = 0.001) in the MetS group compared to the non-MetS patients. No significant differences were identified in other postoperative complications between groups.

CONCLUSIONS: Patients with MetS appear to have an increased risk of postoperative wound complications and readmission after breast reconstruction. The synergistic effects of these comorbidities on postoperative outcomes underscore the importance of addressing MetS as a holistic condition and considering choosing Delayed breast reconstruction over Immediate Breast Reconstruction in this population. Thus, integrating MetS management and patient counseling at various stages of BR may improve outcomes and facilitate patient decision-making.

INTRODUCTION: On most online platforms, just about anyone can disseminate plastic surgery (PS) content regardless of their educational or professional background. This study examines the general public's perceptions of the accuracy of online PS content and the factors that contribute to the discernment of credible information.

METHODS: The Amazon Mechanical Turk crowdsourcing platform was used to survey adults in the United States. The survey assessed respondent demographics, health literacy (HL), and perceptions of online PS content accuracy. T-tests, Chi-square tests, and post hoc analyses with Bonferroni corrections assessed differences between HL groups. Multivariate linear regressions assessed associations between sociodemographic variables and perceptions of online content.

RESULTS: In total, 428 (92.0%) of 465 complete responses were analyzed. The median age of respondents was 32 y (interquartile range: 29-40). Online sources were predominantly perceived to have a high degree of accuracy, with mean scores of various platforms ranging from 3.8 to 4.5 (1 = not accurate at all; 5 = extremely accurate). The low HL group perceived social media sites and review sites to be more accurate than the high HL respondents, particularly for Reddit (P = 0.004), Pinterest (P = 0.040), and Snapchat (P = 0.002).

CONCLUSIONS: There is a concerning relationship between low HL and the perceptions of the accuracy of online PS sources. This study underscores the need for education campaigns, the development of trustworthy online resources, and initiatives to improve HL. By fostering a more informed public, individuals seeking PS can make better informed decisions.

BACKGROUND: Breast cancer is the leading cause of cancer-specific mortality in Hispanic women in the United States. Given the complexity of treatment options, disparities in access to quality care, and increased rates of inadequate or marginal health literacy within this population, these patients face significant barriers to informed decision-making. We aimed to assess the health literacy of Spanish breast cancer surgery websites.

METHODS: A web search using "cirugía de cancer de mama or seno" was performed to identify the top 20 websites in Spanish, divided on the basis of affiliation with academic centers or private institutions and by international/US region. Validated metrics were used to assess readability, understandability, actionability, and cultural sensitivity using Simplified Measure of Gobbledygook in Spanish, Patient Education and Materials Assessment for Understandability and Actionability, and Cultural Sensitivity and Assessment Tool, respectively.

RESULTS: Online materials in Spanish had a mean reading grade level of 10.9 (Simplified Measure of Gobbledygook in Spanish) for academic centers and 10.4 for private institutions. The average understandability score was significantly greater for academic centers at 77% compared with private institutions at 67% (P = .019). Actionability scores were low for both centers at 26% and 37%, respectively. The mean Cultural Sensitivity and Assessment Tool scores were 2.3 and 2.2, respectively.

CONCLUSION: Current Spanish resources for breast cancer surgery are unfitting not only from a readability standpoint but also in their quality and cultural sensitivity. As the Latino population in the United States increases and online resources become more accessible, we must ensure that these resources cater to their target audience, bridging the health care access gap and empowering patients in decision-making.

BACKGROUND: Surgical chest masculinization procedures, especially gender-affirming top surgery (GATS), are becoming increasingly prevalent in the USA. While a variety of surgical techniques have been established as both safe and effective, there is limited research examining ideal aesthetic nipple appearance and incision scar pattern. This study employs patient images to understand the public's perception on top surgery outcomes when adjusting for BMI ranges and Fitzpatrick skin types.

METHODS: Images from RealSelf modified via Adobe Photoshop depicted various scar types and nipple-areolar complex (NAC) sizes/positions. A Qualtrics survey was distributed utilizing Amazon Mechanical Turk. Statistical analysis was performed through JMP Pro 17 for ordinal and categorical values, with a p value less than or equal to 0.05 statistically significant.

RESULTS: A moderately sized and laterally placed NAC was preferred. A transverse scar that resembles the pectoral border between the level of the inframammary fold and pectoral insertion was deemed most masculine and aesthetic. Majority of results demonstrated that this is unaffected by Fitzpatrick skin types. Increased BMI images impacted public preferences, as a nipple placed farther from the transverse incision (p = 0.04) and a transverse scar position closer to the IMF was preferred in higher BMI patients.

CONCLUSIONS: An understanding of the most popular NAC and scar choices, as well as how these factors may differ when considering a Fitzpatrick skin type or BMI categorization was attained. This validates the importance of patient-centered approach when employing surgical techniques in GATS. Future studies intend to obtain reports from actual patients considering GATS.

NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable.

OBJECTIVE: To examine how the recent sharp rise in telemedicine has impacted trends in accessibility of breast reconstruction (BR).

PATIENTS AND METHODS: A retrospective study reviewed patients who underwent a total mastectomy at our institution from 1 August 2016 to 31 January 2022. By comparing cohorts before and during the widespread implementation of telemedicine, we assessed telehealth's impact on healthcare accessibility, measured by distance from patients' residences to our institution.

RESULTS: A total of 359 patients were included in this study. Of those, 176 received total mastectomy prior to the availability of telemedicine, and 183 in the subsequent period. There were similar baseline characteristics among patients undergoing mastectomy, including distance from place of residence to hospital (p = 0.67). The same proportion elected to receive BR between groups (p = 0.22). Those declining BR traveled similar distances as those electing the procedure, both before the era of widespread telemedicine adoption (40.3 and 35.6 miles, p = 0.56) and during the height of telemedicine use (22.3 and 61.3 miles, p = 0.26). When tracking follow-up care, significantly more patients during the pandemic pursued at least one follow-up visit with their original surgical team, indicative of the increased utilization of telehealth services.

CONCLUSIONS: While the rate of BR remained unchanged during the pandemic, our findings reveal significant shifts in healthcare utilization, highly attributed to the surge in telehealth adoption. This suggests a transformative impact on breast cancer care, emphasizing the need for continued exploration of telemedicine's role in enhancing accessibility and patient follow-up in the post-pandemic era.

BACKGROUND: Medical students who attend institutions without plastic surgery residency programs are at a disadvantage in the plastic surgery match. We developed an educational program for medical students without home programs called Explore Plastic Surgery to provide an overview of the steps toward a career in plastic surgery. The purpose of this study was to assess the impact, utility, and success of the novel program.

METHODS: Pre- and postevent surveys were distributed to participants. Survey data were analyzed including participant demographics, perceptions of barriers unique to those without home programs, and the overall event utility.

RESULTS: Two hundred seventeen students registered for the program. Ninety-five participants completed the pre-event survey (44%), and of those, 57 participants completed the post-event survey (60%). There was an increase in understanding of the steps toward a career in plastic surgery ( P < 0.001), confidence in overcoming barriers ( P = 0.005), and level of comfort in reaching out to faculty for opportunities ( P = 0.01). There was a decrease in the perceived negative impact that attending medical schools without a home program will have on their abilities to pursue careers in plastic surgery ( P = 0.006).

CONCLUSIONS: After the event, participants demonstrated an increase in their confidence in overcoming barriers and a decrease in their perceptions that attending an institution without a home program would negatively impact their ability to pursue plastic surgery. Initiatives focused on early exposure and recruitment of medical students may be important to promote accessibility and diversity within plastic surgery.