Common Plastic Surgery Procedures Research Articles

Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence.

Background:The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis.Methods:A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use.Results:Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use.Conclusion:Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

The Effect of Functional Nasal Surgery on Olfactory Function.

Functional and aesthetic nasal operations are some of the most common plastic surgery procedures performed in the United States. The purpose of the study was to evaluate the effects of septoplasty, septorhinoplasty, and rhinoplasty procedures on postoperative olfactory function and their relationship to nasal airflow and quality of life. A systematic review and meta-analysis was performed evaluating olfactory function following nasal surgery. Preoperative and postoperative values for olfaction, nasal airflow, and quality of life/nasal symptoms were analyzed. The effect size was calculated from each study and used for meta-analysis. As studies evaluated patients at different points in the postoperative period, the latest time point reported by each study was used in the meta-analysis. The 95 percent confidence interval of the effect size was calculated for each study. Study quality was assessed using the Jadad and Methodological Index for Nonrandomized Studies instruments. All included studies were Level of Evidence II. There were 25 included studies. Following nasal surgery, patients experienced significant improvements in olfaction (p < 0.001), nasal airflow (p < 0.001), and quality of life/nasal symptoms (p < 0.001). Patients often experienced a transient decrease in olfaction immediately after surgery, followed by improvement postoperatively. Preoperative olfactory dysfunction rates were low and postoperative dysfunction was equally low. Olfaction improvement was directly correlated with improvement in nasal airflow and quality of life. Functional and aesthetic nasal operations appear to significantly improve olfaction, which is directly correlated with nasal airflow. Some studies report a transient worsening of these measures in the immediate postoperative period, which subsequently improved at later time points.

Commentary on: Safety of Large Volume Liposuction in Aesthetic Surgery: A Systematic Review and Meta-Analysis.

Kanapathy et al1 did an excellent review of large volume liposuction. Liposuction is one of the most common surgical procedures in plastic surgery,2 and it has evolved a lot both in how it is performed and the technology employed. One of the most important aspects in the evolution of the technique, in addition to the technologies utilized, has been the volume of fat removed during the surgical procedure. Initially, liposuction was created for the elimination of small volumes of fat located in specific areas.3 However, advances in technology and surgical techniques allowed increasing the amount of fat removed. The first reports of large volume liposuction had as their main limitation the significant bleeding that occurred during surgery, which usually required multiple blood transfusions to perform.4,5 With the advent of tumescent infiltration, the bleeding problem was resolved,6-8 thereby leading to the possibility of increasing...

Panniculectomy Performed in Conjunction With Gynecologic Surgery in Obese and Morbidly Obese Patients: A National Surgical Quality Improvement Program Analysis and Systematic Review of the Literature.

Panniculectomy is a common procedure in plastic surgery, often performed after massive weight loss and in morbidly obese patients. It is also performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates and benefit the patient (Am J Obstet Gynecol, 2000. 182, 1502-1505; J Gynecol Technol, 1997;3:9-16; J Am Coll Surg, 1995). These and other studies fail to provide proof of these claims for a number of reasons, including study design, lack of a control group and the inclusion of nonmorbidly obese patients (J Am Coll Surg, 1995; Gynecol Oncol, 1998, 70, 80-86; Int J Gynecol Cancer, 2015;25(8):1503-1512). Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving toward penalizing practices, which increase complications. The aim of this study was to evaluate the premise that the addition of panniculectomy to gynecologic surgery in the obese and morbidly obese patient population results in a statistically significant improvement in measureable outcomes. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to assess the association of complications with panniculectomy combined with gynecologic surgery in the morbidly obese patient population. The query identified 296 patients with a body mass index greater than 30 who had panniculectomy concomitant with gynecologic surgery. The results demonstrated a statistically significant relationship (P < 0.05) of these concomitant procedures with superficial infection, wound infection, pulmonary embolism, systemic sepsis, return to operating room, length of operation and length of stay. A systematic review of the literature was then performed which identified only 5 studies that included comparative cohorts of those with gynecologic surgery, with and without panniculectomy. There was no significant benefit across the studies in measured paramters. This NSQIP study and systematic review of the existing literature does not support the premise that there is a statistically significant benefit associated with performing panniculectomy in conjunction with gynecologic surgery in the morbidly obese patient population. The NSQIP data demonstrate significant elevation of negative outcomes in morbidly obese patients undergoing combined procedures. In the light of the risks to patients and current direction of medical practice the addition of elective panniculectomy to gynecologic surgery should be reevaluated in the a patient population with a body mass index greater than 30.

Course Review: Mid Yorkshire Plastic Surgery Course-Essential Plastic Surgery Skills for Junior Doctors.

Plastic surgery is niche surgical speciality that is not very well covered in curricula of many medical schools around the world. Junior doctors often feel underprepared and unskilled to deal with basic plastic surgery trauma that commonly presents to the emergency department. Most junior doctors have had very limited or no exposure to common plastic surgery procedures. Simulation training would be one effective way of preparing for such placements.The Mid Yorkshire Plastic Surgery Course, accredited by the British Association of Plastic, Reconstructive, and Aesthetic Surgeons, is an interactive 2-day course that takes place in Wakefield, UK. The Mid Yorkshire Plastic Surgery Course provides delegates with learning opportunities via short, concise lectures followed by longer practical workshops enabling application of theory into immediate practice. It focuses on fundamental plastic surgery skills required to perform key index operating procedures required for entry into higher specialist surgical training. A comprehensive evaluation of this course is conducted in this review.

Commentary on: Understanding Breast Implant Illness.

Breast implant surgery is the most common plastic surgery procedure performed globally. A subset of women with breast implants report experiencing a myriad of disabling and distressing physical and psychological symptoms attributed to their implants. Social media groups have coined the condition "breast implant illness" (BII). Little to no scientific research currently exists for BII. The aim of this study was to investigate the experiences of women with BII (both those with implants still in place and those who have explanted) and compare them with those of a control group of women with implants who do not report BII. Women with self-reported BII and implants still in place (n = 51), self-reported BII who had explanted (n = 60), and women with implants in place without BII (n = 58) completed online self-report questionnaires about their symptoms, physical and mental health, health service use patterns, and lifestyle factors (eg, exercise, smoking, alcohol consumption). Women with BII, regardless of whether they had undergone explant surgery, reported experiencing more severe somatic symptoms, higher depression, anxiety and health anxiety, and poorer physical health than women without BII. These findings highlight the need for further investigation into the causes, risk factors, long-term effects, and potential interventions for women who experience BII.

Opioid Prescribing and Use Following Common Plastic Surgery Procedures

BACKGROUND: Overprescribing of opioids has become a topic of interest given the potential adverse outcomes associated with their use. Excess prescribing of opioids has been shown to have individual and societal impacts such as addiction, dependence, and misuse. Opioids are frequently prescribed for analgesia following plastic surgery procedures. This study aims to investigate prescribing patterns and explores self-reported patient experiences with opioid use, pain control and disposal of unused tablets following common hand and breast surgeries. METHODS: Patients undergoing 5 common predetermined breast procedures and 6 common hand procedures in a specified 14-week period were identified by billing code through health information services. Sixty-two hand procedures 46 breast procedures were identified. Collaboration with opioid monitoring services of the Nova Scotia Provincial Monitoring Program (NSPMP) allowed for data surrounding prescription filling rates, drug type, dose and tablets dispensed. Additionally, all patients were contacted to participate in a structured telephone interview surrounding prescription awareness, pain control, and disposal of excess medication. RESULTS: 55.4% and 41.6% of patients received and filled an opioid prescription following a hand or breast procedure, respectively. Hydromorphone was the most commonly prescribed narcotic for both hand and breast procedures. Average number of opioid tablets dispensed following hand and breast procedures was 36.1 and 31.9, respectively. Forty-eight percent and fifty-two percent of hand and breast patients completed phone interviews. 4.2% of breast patients required an opioid refill, whereas no hand patients did. Seventy-three percent of hand 75% of breast patients used at least one over-counter analgesic, most common being acetaminophen alone. Average self-reported pain score and total pain period was not significantly different between those using opioids and those not for both hand and breast procedures. 6.7% and 23.1% of patients report returning excess narcotics to pharmacy, whereas the majority report still having or self-disposing excess tablets. CONCLUSIONS: Opioid prescriptions are frequent following the procedures studied. In general, opioids appear to be prescribed in excess as denoted by self-report low prescription usage, statistically insignificant differences in pain for those using and not using opioids and low refill rates. Additionally, the majority of unused opioids were noted to be still at home or disposed of inappropriately. Taken together, this study suggests a role for reviewing opioid prescribing patterns for common hand and breast procedures to reduce contributions of excess opioids to an ongoing opioid epidemic.

Determining the Factors Associated With 30- and 90-day Readmissions Following Plastic Surgery Within the National Readmissions Database

PURPOSE: Previous studies have characterized factors associated with readmission following common plastic surgery procedures within 30 days postoperatively. However, with recent changes to the bundled payment plans, forcing medical systems to cover patient care up to 90 days postoperatively, it is imperative that a comprehensive analysis is performed in order to appreciate comorbidities associated with 30- and 90-day readmission. The National Readmission Database (NRD) is a powerful tool to look beyond the current literature at 90-day readmission rates as it provides readmission from over 50% of the population. This study utilized the NRD to describe the comorbidities associated with 30- and 90-day readmissions to help hospitals, healthcare mangers, and plastic surgeons improve patient outcomes and reduce bundled payment penalties. METHODS: The 2012–2014 NRD was mined for reduction mammoplasty and subcutaneous mammectomy, augmentation mammoplasty, mastopexy, total breast reconstruction, and abdominoplasty/panniculectomy based on ICD-9 CM codes. Only patients ≥18, those who had elective surgery, those who had a length of stay <365 days (to avoid confounding chronic-care complications), those with a diagnosis of cancer of the brain/nervous system, currently receiving maintenance chemotherapy/radiotherapy, or those with missing data/discharged to a court of law were also excluded. A bivariate and multivariate analysis was conducted on these patients to determine the significant comorbidities associated with a 30- and 90-day readmission using a Pearson’s chi-square test and Bonferroni correction. Odds ratios were reported to determine the most powerful correlations with readmission. RESULTS: The overall 30-day readmission rate was 5.7%, and the overall 90-day readmission rate was 9.7%. Medical comorbidities that were found to be statistically significant (P < 0.05) in their association with 90-day readmission include anemia deficiency, congestive heart failure, coagulopathy, depression, diabetes, obesity, and hypertension. On multivariate regression analysis of independent predictors of 90-day readmissions, patients that live in fringe counties of metro areas of ≥1 million population (odds ratio [OR] = 0.82; P < 0.05), counties in metro areas of 250,000–999,999 population (OR = 0.79; P < 0.05), and counties in metro areas of 50,000–249,000 population (OR = 0.61; P < 0.05) were less likely to have complicated readmissions. CONCLUSION: Although the overall readmissions for common plastic surgeries is relatively low compared with other major surgical operations, the readmission rate for 90- versus 30-day readmission increased by 4 percentage points and the comorbidity associations with readmissions shifted. This suggests that current literature defining risk factors for postoperative readmission are not sufficient. Further studies to elucidate causal factors through prospective studies should be encouraged and are in need to continue to determine and reduce 90-day readmissions.

Digitizing rhinoplasty: a web application with three-dimensional preoperative evaluation to assist rhinoplasty surgeons with surgical planning

Rhinoplasty is one of the most common and challenging plastic surgery procedures. The results of the operation have a significant impact on the facial appearance. The planning is critical for successful rhinoplasty surgery. In this paper, we present a web application designed for preoperative rhinoplasty surgery planning. The application uses the three-dimensional (3D) model of a patient's face and facilitates marking of an extensive number of facial features and auto-calculation of facial measurements to develop a numerical plan of the surgery. The web application includes definitions, illustrations, and formulas to describe the features and measurements. In addition to the existing measurements, the user can calculate the distance between any two points, the angle between any three points, and the ratio of any two distances. We conducted a survey among experienced rhinoplasty surgeons to get feedback about the web application and to understand their attitude toward utilizing 3D models for preoperative planning. The web application can be accessed and used through any web browser at digitized-rhinoplasty.com. The web application was utilized in our tests and also by the survey participants. The users successfully marked the facial features on the 3D models and reviewed the auto-calculated measurements. The survey results show that the experienced surgeons who tried the web application found it useful for preoperative planning and they also think that utilizing 3D models is beneficial. The web application introduced in this paper helps analyzing the patient's face in details utilizing 3D models and provides numeric outputs to be used in the rhinoplasty operation planning. The experienced rhinoplasty surgeons that participated to our survey agree that the web app would be a beneficial tool for rhinoplasty surgeons. We aim to further improve the web application with more functionality to help surgeons for preoperative planning of rhinoplasty.

Squamous Cell Carcinoma Arising in Breast Implant Capsules.

Breast augmentation and reconstruction utilizing implants are among the most common plastic surgery procedures performed in the United States. A small proportion of these implants are removed each year. We report 2 cases where routine pathologic evaluation of capsulectomy specimens revealed squamous cell carcinoma associated with the breast implant capsule and discuss the possible pathogenesis of this unusual entity. Both patients had long-standing implants (>10 years) and presented with acute unilateral breast erythema and swelling. Intraoperatively, the capsules for both cases appeared thickened and calcified, containing extensive granulomatosis and keratinaceous debris invading into the chest wall. Extensive workup failed to find an occult primary. One patient died from a malignant pleural effusion secondary to tumor invasion during chemotherapy, and the second patient obtained stabilization of the mass after 5 weeks of chemotherapy but subsequently declined further surgical intervention. A thorough literature review was performed, and 5 similar reports were identified, involving 6 patients. All patients presented with similar clinical presentations as ours and had poor outcomes. The mean reporting age at diagnosis was 60 years, and the average time from initial implant to diagnosis was 25 years. Due to the small numbers of squamous cell carcinomas associated with breast implant capsules, the true association between the 2 is unknown. It is postulated that chronic inflammation/irritation from the breast implant and epithelialization of the capsule play a significant role in the disease process. This may represent a new entity of "chronic inflammatory capsular malignancies." Increased awareness of this entity may allow for earlier suspicion, diagnosis, and management.

Evaluation of Aesthetic and Functional Outcomes After Open Rhinoplasty: A Quasi-experimental Study by the Aid of ROE and RHINO Questionnaires.

Rhinoplasty is one of the common plastic surgery procedures which has a high rate in Iran. There are several tools for assessing the outcomes and quality of life after this surgical procedure which rhinoplasty outcome evaluation (ROE) questionnaire and rhinoplasty health inventory and nasal outcomes are two of them. The aim of this study was to investigate the aesthetic and functional outcomes of rhinoplasty by the aid of ROE and RHINO scales in patients who presented to a referral center in Iran. This prospective, quasi-experimental study was performed on patients who referred to the plastic surgery clinic of Imam Khomeini hospital complex during 2017 to 2019 and underwent open rhinoplasty. ROE and RHINO questionnaires were filled by patients before and 6months after the surgery. Surgical outcomes and aesthetic satisfaction rate were evaluated in different age groups, genders and educational levels. The data were analyzed by version 21 of SPSS software. ROE score increased from 51.27 ± 10.54 to 79.6 ± 9.67 (P < 0.001). In addition, RHINO score increased from 64.13 ± 11.43 to 83.36 ± 11.03 (P < 0.001). The most common satisfaction factors among patients in this study were "nose feels more natural" in 62% of patients and "tip rotation is good" in 32% of patients. Furthermore, the most common causes of dissatisfaction in patients were "nose too wide" in 25% of patients and "tip bulbous" in 25% of patients. ROE and RHINO scales are effective for assessing rhinoplasty outcomes. The satisfaction rate of rhinoplasty is high in Iran and is related to the natural shape of the nose in addition to the tip rotation. 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 .

A Comparison of Common Plastic Surgery Operations Using the NSQIP and TOPS Databases.

Using the 2008-2016 TOPS and NSQIP databases, we compared patient characteristics and postoperative outcomes for 5 common plastic surgery procedures. A weighted TOPS population was used to mirror the NSQIP population in clinical and demographic characteristics to compare postoperative outcomes. We identified 154,181 cases. Compared with NSQIP patients, TOPS patients were more likely to be younger (47.9 versus 50.0 years), have American Society of Anesthesiologists class I-II (92.1% versus 74.6%), be outpatient (66.0% versus 49.3%), and be smokers (18.7% versus 11.7%). TOPS had extensive missing data: body mass index (40.6%), American Society of Anesthesiologists class (34.9%), diabetes (39.3%), and smoking status (37.2%). NSQIP was missing <1% of all shared categories except race (15.6%). The entire TOPS cohort versus only TOPS patients without missing data had higher rates of dehiscence (5.1% versus 3.5%) and infection (2.1% versus 1.7%). TOPS versus NSQIP patients had higher dehiscence rates (5.1% versus 1.0%) but lower rates of return to the operating room (3.1% versus 6.6%), infection (2.1% versus 3.0%), and medical complications (0.3% versus 2.2%). Nonweighted and weighted TOPS cohorts had similar 30-day outcomes. NSQIP and TOPS populations are different in characteristics and outcomes, likely due to differences in collection methodology and the types physicians using the databases. The strengths of each dataset can be used together for research and quality improvement.

Interest in Plastic Surgery during COVID-19 Pandemic: A Google Trends Analysis.

The coronavirus pandemic emerged in the United States in Spring 2020. The resulting economic upheaval was substantial, demonstrated by a 1072% increase in unemployment claims over a single week.1 In efforts to maximize hospital bed capacity, elective surgical procedures were either formally suspended or discouraged in many jurisdictions.2 Stay-at-home orders and social distancing efforts have spurred the rapid adoption of telemedicine alternatives for patient care.3 This combination has laid a foundation which many plastic surgeons worry may decrease patient interest in surgical and nonsurgical procedures. However, limited information is available to quantify these concerns. Here, we present for the first time an analysis of Google Trends data focused on popular plastic-surgery–related search terms following the emergence of COVID-19 in the United States. Google Trends search filters were designed to collect data related to common plastic surgery procedures in the United States, from June 2018 through July 2020. Search terms were based on the most common surgical and nonsurgical procedures reported in the American Society of Plastic Surgeons 2019 survey.4 When available, Google Trends topic data were used in lieu of specific terminology to better capture procedure-specific terminology and colloquialisms (ie, “tummy-tuck” has been captured as the most searched term related to abdominoplasty). Our findings demonstrate the destabilizing effect of the coronavirus pandemic on search terminology related to plastic surgery. Coinciding with the first COVID-19-related death in the United States on February 29, 2020, and the national declaration of emergency on March 13, 2020, there was a precipitous drop in search engine traffic in early 2020, and the interest in nonsurgical procedures approached an all-time low (Fig. 1). However, the public’s interest rapidly recovered, with 2-year peaks reached for some terms beginning in April 2020 and into the current summer season. A similar trend is observed in surgical procedure keywords. Two-year troughs were reached for all terms, with rapid return to baseline or, in some cases, new peaks (Fig. 2). Google-Trends–based analyses have previously been shown to correlate with the actual number of procedures performed, although there are inherent limitations worth noting.5 Data represent a deidentified amalgam of searches from potential and prior patients, physicians, and third parties. Still, search-engine–based analysis is a facile, readily available means to gauge interest for surgical procedures on a nationwide level. While the United States was impacted uniformly during the initial adjustment to COVID-19, a heterogeneous pattern of poorly controlled hotspots has emerged. If this pattern continues, it is reassuring for plastic surgeons that patient interest appears to rebound over a short period of time. It would be beneficial to further investigate the locoregional impact of COVID-19 on interest in plastic surgery procedures. In conclusion, while interest in plastic surgery was acutely impacted by COVID-19, search interest was able to rapidly recover to baseline and reached new peaks. With more consumers working remotely from home, patients may be able to take advantage of unique opportunities to recuperate from procedures, with less downtime from work compared with that during pre-pandemic times.Fig. 1.: Public interest in common non-surgical procedures (Botox, hyaluronic acid fillers, and laser hair removal) pre- and post-COVID-19 pandemic.Fig. 2.: Public interest in most common plastic surgery procedures (breast augmentation, liposuction, mastopexy, abdominoplasty, and blepharoplasty) pre- and post-COVID-19 pandemic.

Geriatric Patients Carry Increased Risk for Deep Venous Thrombosis and Pulmonary Embolism in Reduction Mammaplasty: An Analysis of 1897 Geriatric Patients Among 25,909 Cases From 2005 to 2017 National Surgical Quality Improvement Project Databases.

Reduction mammaplasty is one of the most common plastic surgery procedures performed. No study has evaluated whether geriatric patients are at greater risk for developing postoperative complications relative to nongeriatric patients. The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was reviewed for reduction mammaplasty procedures from 2005 to 2017. Hypothesis testing for demographics, comorbidities, and postoperative complications between geriatric and nongeriatric patients was performed. Statistically significant differences were then evaluated with multivariate logistic regression analysis. A total of 25,909 reduction mammaplasties were collected by NSQIP from 2005 to 2017, with 1897 patients older than 64 years (8% of all cases). The average age for geriatric breast reduction patients was 69 years versus 41.5 years for nongeriatric patients. Rates of comorbidities including diabetes, smoking status, dyspnea status, and hypertension medication were statistically different between the groups. Rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) were significantly higher in geriatric versus nongeriatric patients, respectively (0.32 vs 0.06, P < 0.001 and 0.37 vs 0.09, P < 0.001). Multivariate analysis demonstrated geriatric patients had a 4.2 and 3.9 times higher risk of developing a DVT and PE than nongeriatric patients (C.I. 1.5-11.6, P = 0.006 and C.I. 1.6-9.8, P = 0.004). This study represents the largest evaluation of geriatric reduction mammaplasties in the United States. Although rare, geriatric age confers a 4 times increased risk for developing DVT and PE relative to nongeriatric patients all while adjusting for preoperative risk factors in reduction mammaplasty. Plastic surgeons should consider counseling their geriatric patients regarding these increased risks.

Applying Average Anthropometric Reference Measurements to Thigh Lift Surgical Design in Females: A Novel Technique

Background: Thigh lift is a common procedure in plastic surgery. Surgeon’s sense or tailor tacdundancy to bek is mainly the methods used for designing thigh lift currently. This article is an attempt to find a method/a reference point to define the exact amount of re excised. Introduction: Anthropometry reference measurements can be applied in designing thigh lift surgery. Classically, anthropometry binds the calf circumference with mid-thigh circumference and upper thigh (gluteal) circumference to make postoperative results more harmonious and natural. Method: To find out the anthropometrically referenced ratio of the calf circumference with mid-thigh circumference and upper thigh (gluteal) circumference, anthropometric databases and studies done on females addressing different ages, countries and races with average BMI (body mass index) were reviewed. Chosen studies should include the calf circumference, mid-thigh circumference and/or upper thigh (gluteal) circumference. Anthropometrically referenced upper and mid-thigh circumferences can be calculated preoperatively. Result: 64:92:100 was concluded as a pooled mean ratio out of nine different studies addressing the ratio of the calf circumference:mid-thigh circumference:upper thigh (gluteal) circumference. Conclusion: Postoperative anthropometrically referenced mid and upper thigh circumferences can be calculated by measuring the calf circumference and applying the 64:92:100 ratio. Markings are done intraoperatively using my innovated “Stab-Push-Pinch-Mark” or SPPM technique for drawing a rough surgical design, then tweaked using the anthropometrically referenced 64:92:100 ratio results.

Transcutaneous oxygen measurement using ratiometric fluorescence imaging as a valid method for monitoring free flap transplants.

Reconstruction of soft tissue defects with free flaps is a common procedure in plastic and reconstructive surgery. Most postoperative complications occur within the first 48-72 hours after surgery. After postoperative complications, short perfusion restoration times may improve flap survival rates by up to 30-50%. Ratiometric fluorescence imaging is an additional or alternative method of postoperative flap monitoring. To test the efficacy and utility of transepidermal oxygen flux imaging to evaluate postoperative skin oxygenation of free and local flaps in the first 48 hours after surgery. The study included 32 patients (aged between 18 and 80 years; mean age 52.9) with a tissue defect covered with a free flap transplant at the Department of Plastic and Reconstructive Surgery of the University Medical Center Regensburg. Postoperative oxygen flux was measured with the 'VisiSens system' placed on the vascular pedicle as well as on the peripheral and central part of the flap. Values of oxygen flux were higher in case of flap congestion (0.069±0.012) or flap necrosis (0.155±0.083) than in cases without any complications (0.061±0.006). Flux values of different areas of the same flap showed only minimal differences (central part: 0.065±0.008, peripheral part: 0.070±0.009, vascular pedicle: 0.056±0.004); the level of significance was p = 0.904. Imaging transepidermal oxygen flux by ratiometric luminescence seems to be a reliable alternative, indirect method of postoperative flap monitoring with regard to microcirculatory function and flap viability.

YouTube for Cosmetic Plastic Surgery: An Effective Patient Resource?

YouTube is increasingly being utilized as a major educational resource by patients. It is important for plastic surgeons to understand the quality and characteristics of videos that patients are likely to view about procedures of interest. The aim of this study was to evaluate the quality of the videos that patients are most likely to encounter when searching YouTube for the most common cosmetic plastic surgery procedures. Based on Google Trends data, the most searched medical and colloquial terms were identified for common cosmetic surgery procedures: "abdominoplasty," "tummy tuck," "breast augmentation," "boob job," "liposuction," "lipo," "mastopexy," "breast lift," "reduction mammoplasty," and "breast reduction." On YouTube, videos were searched by relevance (default) and view count; the top 10 results were collected in each group and rated according to the DISCERN criteria. Each video was assigned an overall and bias DISCERN score (DS). A score of 1 indicates high bias and low overall quality and a score of 5 indicates the opposite. In total, 143 unique videos were identified, which resulted in a mean bias DS of 2.29 and mean overall DS of 2.44. Seventy-two videos included US board-certified plastic surgeons and 58 were classified as patient experience. Videos had 667,373,209 total views and were an average of 4.27 years old. Videos including US board-certified plastic surgeons were of significantly higher quality and showed lower bias than videos without these practitioners (P < 0.05). Overall, YouTube videos showed high bias and low quality. Plastic surgeons should be aware of this popular resource and counsel patients about the bias that is often present. Plastic surgeons and academic plastic surgery organizations should strive to upload high-quality, unbiased videos to provide patients with a more appropriate resource.

Multilevel Breast Reduction: A Retrospective Study of 338 Breast Reduction Surgeries.

Background:Aesthetic breast reduction is a common plastic surgery procedure with the potential for considerable improvement of the patient’s quality of life in addition to its aesthetic value. Many different approaches have been described for breast reduction to improve upon previous techniques in terms of scarring, nipple position, amount of breast tissue excised, shape, and longevity of the results. However, medium size resections in ptotic and wide breasts are difficult to treat using both the most common inferior pedicle wise procedure and the various vertical scar techniques.Methods:A retrospective study of 338 consecutive bilateral breast reduction patients between January of 2010 and January of 2018 at a single center by a single surgeon using a vertical scar technique. Demographic and postoperative outcome data were collected and evaluated.Results:Patient satisfaction with the results was high. Complication rates were comparable or lower than previously published series. Major complications requiring revision surgery: 3 (0.8%) hematomas; minor complications: 68 (20%) cases of superficial dehiscence; 12 (3.5%) superficial surgical site infections; 11 (3.2%) seromas; 4 (1.2%) fat necrosis; and 1 (0.2%) partial areola necrosis.Conclusion:The Borenstein Breast Reduction technique aims to recreate the breast mound support from the “bottom up” facilitating long-lasting results and high patient satisfaction rates. This approach can be helpful in all breast reductions and is most effective in wide ptotic breasts.

Female Genital and Vaginal Plastic Surgery: An Overview.

After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery. This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.

Incidental breast carcinoma: incidence, management, and outcomes in 4804 bilateral reduction mammoplasties.

Bilateral reduction mammoplasty is one of the most common plastic surgery procedures performed in the U.S. This study examines the incidence, management, and prognosis of incidental breast cancer identified in reduction specimens from a large cohort of reduction mammoplasty patients. Breast pathology reports were retrospectively reviewed for evidence of incidental cancers in bilateral reduction mammoplasty specimens from five institutions between 1990 and 2017. A total of 4804 women met the inclusion criteria of this study; incidental cancer was identified in 45 breasts of 39 (0.8%) patients. Six patients (15%) had bilateral cancer. Overall, the maximum diagnosis by breast was 16 invasive cancers and 29 ductal carcinomas in situs. Thirty-three patients had unilateral cancer, 15 (45.5%)of whichhad high-risk lesions in the contralateral breast. Twenty-one patients underwent mastectomy (12 bilateral and nine unilateral), residual cancer was found in 10 in 25 (40%) therapeutic mastectomies. Seven patients did not undergo mastectomyreceived breast radiation. The median follow-up was 92months. No local recurrences were observed in the patients undergoing mastectomy or radiation. Three of 11 (27%) patients who did not undergo mastectomy or radiation developed a local recurrence. The overall survival rate was 87.2% and disease-free survival was 82.1%. Patients undergoing reduction mammoplasty for macromastia have a small but definite risk of incidental breast cancer. The high rate of bilateral cancer, contralateral high-risk lesions, and residual disease at mastectomy mandates thorough pathologic evaluation and careful follow-up of these patients. Mastectomy or breast radiation is recommended for local control given the high likelihood of local recurrence without either.