Review of Outcomes in Prepectoral Prosthetic Breast Reconstruction with and without Surgical Mesh Assistance.

Background: In the past decade, surgeons have increasingly advocated for a return to prepectoral breast reconstruction with claims that surgical mesh (including acellular dermal matrix) can reduce complication rates. However, numerous surgical and implant advancements have occurred in the decades since the initial prepectoral studies, and it is unclear whether mesh is solely responsible for the touted benefits.

Methods: The authors conducted a systematic review of all English language articles reporting original data for prepectoral implant-based breast reconstruction.

Overview of Host Defense Peptides and Their Applications for Plastic and Reconstructive Surgeons.

Background: Host defense peptides are a family of endogenous short peptides that are found in all living beings and play a critical role in innate immunity against infection.

Methods: A nonsystematic review of host defense peptides was conducted with specific interest in properties and applications relevant to plastic and reconstructive surgery.

Results: In addition to their direct antimicrobial actions against pathogens, including multidrug-resistant bacteria, they also demonstrate important functions in immunomodulation, tumor cell lysis, and tissue regeneration.

Systematic Review of the Impact of Acellular Dermal Matrix on Aesthetics and Patient Satisfaction in Tissue Expander-to-Implant Breast Reconstructions.

Background: Acellular dermal matrix is used in most postmastectomy implant-based breast reconstructions in the United States. It is believed to be safe, despite a slightly increased complication rate. Although never established in a unifying study, the primary advantage of acellular dermal matrix is believed to be an enhanced aesthetic result, thus justifying the added expense.

Feasibility and Efficacy of Decision Aids to Improve Decision Making for Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis.

Background: The decision-making process for women considering breast reconstruction following mastectomy is complex. Research suggests that fewer than half of women undergoing mastectomy have adequate knowledge and make treatment decisions that are concordant with their underlying values. This systematic review assesses the feasibility and efficacy of preoperative decision aids (DAs) to improve the patient decision-making process for breast reconstruction.

Evolving Trends in Textured Implant Use for Cosmetic Augmentation in the United States.

Background: Breast implants have evolved for decades. In 2011, the U.S.

Hospital Variations in Clinical Complications and Patient-reported Outcomes at 2 Years After Immediate Breast Reconstruction.

Objective: Our objectives were to investigate case-mix adjusted hospital variations in 2-year clinical and patient-reported outcomes following immediate breast reconstruction.

Background: Over the past few decades, variations in medical practice have been viewed as opportunities to promote best practices and high-value care.

Methods: The Mastectomy Reconstruction Outcomes Consortium Study is an National Cancer Institute-funded longitudinal, prospective cohort study assessing clinical and patient-reported outcomes of immediate breast reconstruction after mastectomy at 11 leading medical centers.

Fees for Certification and Finances of Medical Specialty Boards.

This study investigates fees charged to physicians for certification examinations and finances of the American Board of Medical Specialties member boards.

Latissimus Dorsi Flap Breast Reconstruction-A Nationwide Inpatient Sample Review.

Introduction: The latissimus dorsi (LD) myocutaneous flap has been a long term standard for breast reconstruction. The variable indications for the LD flap have not been statistically examined because of the relative infrequency of its use by any single surgeon or institution.

Methods: The Nationwide Inpatient Sample data set was queried for all patient encounters involving a LD myocutaneous flap procedure.

Revenue Generation and Plastic Surgery Training Programs: 1-Year Evaluation of a Plastic Surgery Consultation Service.

Background: In academic institutions, residents make substantial contributions to clinical productivity. However, billing cannot be generated unless there is direct attending physician supervision of these services. The purpose of this study was to quantify clinical services provided by residents at a large academic medical center.

Unnecessary Emergency Transfers for Evaluation by a Plastic Surgeon: A Burden to Patients and the Health Care System.

Background: Plastic surgeons are frequently consulted for hand and facial injuries, and patients are often transferred to trauma centers for evaluation of these problems. The authors sought to identify the frequency and impact of "unnecessary" transfers for emergency evaluation by a plastic surgeon at a Level I trauma center.

Methods: The authors reviewed more than 32,000 consecutive emergency department encounters at their institution between April of 2009 and April of 2013 and found 1181 patients transferred for evaluation by plastic surgery.

Promoting medical student research productivity: the student perspective.

One-third of medical students complete medical school without significant exposure to research. This gap in their medical education is significant: research not only exposes medical students to scientific methodology and academic writing, but also encourages them to multi-task, communicate, and critically analyze the scientific literature - valuable skills that will serve them well in their future medical careers. We report herein the proceedings from a student-led symposium that aimed to promote student involvement in research at the Alpert Medical School of Brown University by providing practical information on how to successfully complete a research project.

Factors influencing fellowship selection, career trajectory, and academic productivity among plastic surgeons.

Background: Several factors influence the career trajectory of graduating plastic surgeons, and the authors' study sought to capture characteristics of plastic surgery trainees as they relate to outcomes, including fellowship selection, career choice, and academic productivity.

Methods: Anonymous online survey data were obtained from members of the American Society of Plastic Surgeons. Correlative analysis was performed implementing the Pearson chi-square test, the Mann-Whitney test, and the Kendall tau-b correlation to determine significant correlations defined by values of p < 0.

Clinically meaningful tumor reduction rates vary by prechemotherapy MRI phenotype and tumor subtype in the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657).

Purpose: This study was designed to determine (1) rates of clinically meaningful tumor reduction in breast tumor size following neoadjuvant chemotherapy (NAC), (2) which receptor subtypes and MRI phenotypes are associated with clinically meaningful tumor reduction, and (3) whether MRI phenotype impacts concordance between pathologic and MRI size.

Methods: We analyzed data from the I-SPY TRIAL, a multicenter, prospective NAC trial. Reduction in tumor size from >4 to ≤4 cm was considered clinically meaningful, as crossing this threshold was considered a reasonable cutoff for potential breast conservation therapy (BCT).

Elevated levels of proliferating and recently migrated tumor-associated macrophages confer increased aggressiveness and worse outcomes in breast cancer.

Purpose: Macrophages play a major role in inflammatory processes and have been associated with poor prognosis in a variety of cancers, including breast cancer. Previously, we investigated the relationship of a subset of tumor-associated macrophages (PCNA(+) TAMs) with clinicopathologic characteristics of breast cancer. We reported that high PCNA(+) TAM counts were associated with hormone receptor (HR)-negative, high-grade tumors and early recurrence.

Genome-wide functional profiling reveals genes required for tolerance to benzene metabolites in yeast.

Benzene is a ubiquitous environmental contaminant and is widely used in industry. Exposure to benzene causes a number of serious health problems, including blood disorders and leukemia. Benzene undergoes complex metabolism in humans, making mechanistic determination of benzene toxicity difficult.

Biologic markers determine both the risk and the timing of recurrence in breast cancer.

Breast cancer has a long natural history. Established and emerging biologic markers address overall risk but not necessarily timing of recurrence. 346 adjuvant naïve breast cancer cases from Guy's Hospital with 23 years minimum follow-up and archival blocks were recut and reassessed for hormone-receptors (HR), HER2-receptor and grade.