A classification system and treatment algorithm for mastectomy flap ischemia in alloplastic breast reconstruction.

Background: Mastectomy flap necrosis remains a major cause of failed breast reconstruction with an associated significant financial/psychological burden. Language describing ischemic mastectomy flaps is imprecise as ischemia can result from many causes and can manifest in different ways. Similarly, management of mastectomy flap ischemia varies depending on its etiology.

Surgically Treated Hernia following Abdominally Based Autologous Breast Reconstruction: Prevalence, Outcomes, and Expenditures.

Background: Donor-site hernia is one of the most feared complications following abdominally based autologous breast reconstruction. The authors aim to assess the incidence of surgically repaired abdominal hernia across different types of abdominally based breast reconstruction, identify predictive perioperative factors, and estimate the health care charges associated with this morbidity.

Methods: Using inpatient and ambulatory surgery data from four states in the United States, the authors identified adult women who underwent pedicled transverse rectus abdominis muscle (TRAM), free TRAM, or deep inferior epigastric perforator (DIEP) flap breast reconstruction between 2008 and 2012.

Superficial Inferior Epigastric Artery: Learning Curve versus Reality.

Background: Breast reconstruction with the superficial inferior epigastric artery (SIEA) free flap continues to gain popularity among reconstructive surgeons. The low risk for abdominal wall morbidity must be weighed against the higher concern for thrombotic events. The aim of this study was to review the authors' recent experience with the SIEA flap and investigate whether their previously published incidences of vessel thrombosis and flap loss were related to their own "learning curve" or whether these adverse events are attributable to inherent qualities of the SIEA flap.

Geographic Variation in Access to Plastic Surgeons.

Introduction: While recent studies project a national shortage of plastic surgeons, there may currently exist areas within the United States with few plastic surgeons. We conducted this study to describe the current geographic distribution of the plastic surgery workforce across the United States.

Methods: Using the 2013 to 2014 Area Health Resource File, we estimated the number of plastic surgeons at the health service area (HSA) level in 2010 and 2012.