"Plastic Surgery Program Leadership Perspectives on Wellness and Professional Development Curricula-Where are we Now?".

Background: Burnout is common amongst surgical trainees and its consequences can be detrimental to both mental health and patient care. As such, wellness and professional development have moved to the forefront of discussion in surgical education. The purpose of this study is to describe the current landscape of wellness and professional development education, as well as barriers to initiation of dedicated curricula.

Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction.

Background:  Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of postoperative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss.

Methods:  A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009 and 2020 analyzed operative variables and patient outcomes, with complications determined from the operative report.

Who Posts on Instagram? Using Natural Language Processing to Assess the Relationship Between Training Background and Content of 700,000 Posts.

Background: Instagram (Menlo Park, CA) is a major platform for the dissemination of plastic surgery (PS) information, but the training background of users is difficult to ascertain.

Objectives: We sought to better characterize the source and content of PS-related posts on Instagram.

Methods: Metadata from publicly available Instagram posts containing PS relevant hashtags was collected from December 2018 to August 2020 using Node.

Interplay of Oncoplastic Reconstruction and Adjuvant Radiation Therapy in Breast Cancer.

Purpose: Oncoplastic breast surgery (OBS) combines breast cancer tumor removal with the cosmetic benefits of plastic surgery at the time of breast-conserving surgery. Potential advantages of OBS include wider surgical margins around the tumor bed, while the natural shape and appearance of the breast are maintained more than standard lumpectomy procedures. However, limited information is available regarding the potential effect on adjuvant radiation treatment planning.

An Updated Systematic Review and Meta-Analysis of Tissue Oximetry Versus Conventional Methods for Postoperative Monitoring of Autologous Breast Reconstruction.

Background: Tissue oximetry monitoring has shown superior outcomes to conventional monitoring methods for autologous breast reconstruction in retrospective studies with consecutive cohorts. A recent study used consecutive cohorts with tissue oximetry as the earlier cohort and found that tissue oximetry was nonsuperior. We hypothesize that improvement in microsurgical outcomes with institutional experience confounds the superiority of tissue oximetry demonstrated in prior studies.

Predicting Complications in Breast Reconstruction: Development and Prospective Validation of a Machine Learning Model.

Importance: Necrosis of the nipple-areolar complex (NAC) is the Achilles heel of nipple-sparing mastectomy (NSM), and it can be difficult to assess which patients are at risk of this complication (Ann Surg Oncol 2014;21(1):100-106).

Objective: To develop and validate a model that accurately predicts NAC necrosis in a prospective cohort.

Design: Data were collected from a retrospectively reviewed cohort of patients who underwent NSM and immediate breast reconstruction between January 2015 and July 2019 at our institution, a high -volume, tertiary academic center.

Defining the Incidence of the Impostor Phenomenon in Academic Plastic Surgery: A Multi-Institutional Survey Study.

Background: Impostor phenomenon occurs when high-achieving individuals have persistent self-doubt despite objective measures of competence and success, and has been associated with professional burnout and attenuated career advancement in medical specialties. This study aimed to define the incidence and severity of the impostor phenomenon in academic plastic surgery.

Methods: A cross-sectional survey containing the Clance Impostor Phenomenon Scale (range, 0 to 100; higher scores indicate greater severity of impostor phenomenon) was distributed to residents and faculty from 12 academic plastic surgery institutions across the United States.

Autologous Breast Reconstruction Success Rates in Hypercoagulable Patients.

Background: Hypercoagulable disorders may adversely affect microsurgical outcomes, including increased flap failure and complication rates. Outcomes specific to autologous breast reconstruction are not well described.

Methods: A retrospective review was performed of autologous breast reconstructions between 2009 and 2020.

Autologous Breast Reconstruction after Massive Weight Loss: Understanding Risks in a Growing Population.

Background: Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rising rates of obesity and bariatric surgery, more patients who have experienced MWL will be presenting for breast reconstruction. The authors hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared with reconstruction in patients without a history of MWL.

Closed-Incision Negative Pressure Therapy Prevents Major Abdominal Donor-Site Complications in Autologous Breast Reconstruction.

Background: Outcomes in autologous breast reconstruction continue to improve with refinements in microsurgical techniques; however, donor-site morbidity remains a concern. Closed-incision negative pressure therapy (ciNPT) has been shown to reduce wound complications. Limited evaluation in abdominal donor sites has shown promising results.

Evaluating the Importance of Sub-Internships on the 2022 Integrated Plastic Surgery Match During Continued COVID-19 Regulations.

Objective: Following the 2021 integrated plastic surgery match, we found a significant increase in home match rates and decrease in match rate for students without a home plastic surgery program with the elimination of visiting sub-internships and the initiation of virtual interviewing. With the return of visiting sub-internships in the 2022 match cycle, we hypothesize that these rates will approach values more consistent with historical controls.

Design: Program match data was obtained from posts to residency program Instagram pages and posts associated with the hashtag #PRSMatch2022.

A Paradigm Shift: Outcomes of Early Autologous Breast Reconstruction after Radiation Therapy.

Background:  Radiation creates significant challenges for breast reconstruction. There is no consensus regarding optimal timing for autologous reconstruction following radiation. This study explores clearly defined, shorter time intervals between completion of radiation and reconstruction than previously reported.

Characterizing Outcomes of Medial and Lateral Perforators in Deep Inferior Epigastric Perforator Flaps.

Background:  Perforators are typically found in rows in the deep inferior epigastric perforator (DIEP) flap. As methods to assess flap perfusion continue to improve, surgeons may be more likely to select perforators traditionally avoided. The purpose of this article is to describe clinical outcomes based on row and number of perforators to reevaluate flap and abdominal donor site morbidity.

Comparing tissue oximetry to doppler monitoring in 1367 consecutive breast free flaps.

Background: Retrospective studies evaluating tissue oximetry in a more recent cohort have shown superiority in flap outcomes. This study compares the use of tissue oximetry in a historical cohort to clinical observation and handheld doppler in a more recent cohort. We hypothesize that there is no benefit to using tissue oximetry.

Effect of COVID-19 Restrictions on 2021 Integrated Plastic Surgery Match Outcomes.

Objective: Due to the Coronavirus Disease 2019 Pandemic (COVID-19), guidelines regarding both elimination of visiting subinternships and substitution of virtual interviews for the 2021 match were adopted. We hypothesize that these changes will result in an increase in home institution match rates compared to previous years.

Design: Program match data was obtained using information posted to residency program Instagram pages and the hashtag #PRSMatch2021.

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients.

Given global trends in obesity and bariatric surgeries, there are an increasing number of women presenting for breast reconstruction after massive weight loss. There is a paucity of literature about breast reconstruction after mastectomy in patients with a history of massive weight loss. A literature review revealed 10 articles that discussed outcomes of different reconstruction techniques in patients with massive weight loss.

Patient Satisfaction Increases with Nipple Reconstruction following Autologous Breast Reconstruction.

Background: Nipple reconstruction has been linked to patient satisfaction; however, there is debate about the validity of these findings in autologous breast reconstruction patients. This study hypothesized that satisfaction would increase with nipple reconstruction following autologous breast reconstruction.

Methods: A comparison study was performed of autologous breast reconstruction patients.

Global Trends in Plastic Surgery on Social Media: Analysis of 2 Million Posts.

Background: Plastic surgeons and patients increasingly use social media. Despite evidence implicating its importance in plastic surgery, the large volume of data has made social media difficult to study.

Objectives: The aim of this study was to provide a comprehensive assessment of plastic surgery social media content worldwide by utilizing techniques for analyzing large-scale data.

A Comparative Analysis of Outcomes of Free Nipple Areolar Grafting in Autologous Breast Reconstruction.

Background:  Preserving the nipple areolar complex (NAC) increases satisfaction in breast reconstruction. This study aims to describe outcomes using free NAC grafts in microvascular breast reconstruction.

Methods:  A case-control study evaluated prospective outcomes of microvascular breast reconstruction with free NAC grafts compared with matched controls with tattoo or local flap nipple reconstruction.

Do Nipple Necrosis Rates Differ in Prepectoral Versus Submuscular Implant-Based Reconstruction After Nipple-Sparing Mastectomy?

Background: Nipple-sparing mastectomy (NSM) has become increasingly popular, given its oncologic safety and preserved nipple areolar complex (NAC) aesthetics. Reconstruction has recently shifted from traditional submuscular (SM) to prepectoral (PP) implant placement. It remains unclear how the plane of implant placement might affect NAC perfusion.

Phlegmasia cerulea dolens following internal hemipelvectomy: Case report and literature review.

Phlegmasia cerulea dolens (PCD) results from near complete venous thrombosis and occlusion in an extremity resulting in pain, cyanosis, and edema and potentially death. While PCD can result from a variety of mechanisms including trauma, iatrogenic instrumentation, the majority of cases occur in the setting of malignancy. PCD is often managed medically with anticoagulation.

Happiness in Plastic Surgery: A Cross-Sectional Analysis of 595 Practicing Plastic Surgeons, Fellows, Residents, and Medical Students.

Background: Despite a heightened appreciation for wellness in medicine, there exists little information specific to plastic surgery. The purpose of this research was to assess happiness within the field of plastic surgery.

Methods: A cross-sectional study was conducted in July of 2017 by distributing an American Society of Plastic Surgeons sponsored survey to a random cohort of current practicing American Society of Plastic Surgeons members, residents and fellows.

Chyle Leak Following Autologous Breast Reconstruction: A Rare Complication of a Deep Inferior Epigastric Artery Perforator Flap.

Background: While complications of deep inferior epigastric artery perforator flaps are known and well documented, a thorough literature review revealed no other reports of a patient developing a chyle leak following the use of the internal mammary vessels for recipient vessels in autologous breast reconstruction.

Case: A 55-year-old woman underwent free autologous breast reconstruction. She developed a chyle leak during the postoperative period.