While patient satisfaction ratings are increasingly used as hospital and provider performance metrics, these ratings may be affected by factors extraneous to surgeon performance. This study aims to assess whether outpatient Press Ganey ratings for plastic surgery providers were tied more to provider or patient characteristics. All Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) responses for plastic surgery providers from 2017 to 2023 from a single institution were analyzed. Ordered logistic regression models were used to identify characteristics associated with provider ratings. 6,442 surveys from 4,594 patients representing 29 plastic surgery providers were analyzed. Across the patient cohort, 23.2% (N = 1,492) rated plastic surgery providers lower than a 10/10. After adjustment, provider characteristics including provider gender, patient-provider gender concordance, and years in practice were not associated with overall provider ratings (all p > 0.05). In contrast, patient characteristics were associated with provider ratings. Older patient age [Odds Ratio (OR) 1.02; p < 0.001)] was associated with higher ratings. Finally, self-reported overall health and mental health were associated with lower provider ratings (both p < 0.05); specifically, mental health categories lower than 'Excellent' were associated with significantly lower provider ratings (Overall Mental Health 'Very Good': OR 0.57; 'Good' OR 0.53; 'Fair': OR 0.59; 'Poor' OR 0.55; all p < 0.05). Press Ganey ratings for plastic surgeons are influenced by patient characteristics, including age and mental health. As satisfaction ratings are increasingly used as performance metrics in plastic surgery, adjusted rating models may be needed to more accurately reflect surgeon performance.

Modern aesthetically optimized breast reconstruction requires collaboration between the patient, breast surgeon, and plastic surgeon. In order to optimize both surgical outcomes and aesthetic results, incision patterns must be carefully planned. We aim to determine whether vertical or horizontal orientation of mastectomy incision is preferred in the general population as well as analyze corresponding complication profiles. A retrospective review of all patients undergoing bilateral mastectomy followed by autologous breast reconstruction utilizing either vertical or horizontal incision from January 2011 to November 2022. Postoperative complications of the 2 incisions patterns were analyzed. Additionally, crowdsourcing was utilized to assess aesthetic implications of horizontal and vertical incision patterns on postoperative pictures of completed breast reconstruction. Survey rater demographics were also analyzed to assess differences in scoring based on voter characteristics. There were no significant differences in postoperative breast complications between patients with horizontal or vertical incisions when looking at wounds, infections, seromas, hematomas, fat necrosis, or overall complications (p > 0.05). Crowdsourcing showed that regardless of voter demographics, vertical incisions were preferred over horizontal incisions (p < 0.001). Additionally, voters who knew someone who had undergone breast reconstruction were more likely to rate all incision patterns higher than other voters (p < 0.001). While there are no significant differences in complication profiles between vertical and horizontal incisions in autologous breast reconstruction patients, vertical incision patterns are preferred aesthetically by the general population.