Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Nipple malposition following nipple sparing mastectomy: Evaluation of secondary correction in prepectoral implant-based breast reconstruction","authors":"Shahnur Ahmed ,&nbsp;John P. Hajj ,&nbsp;Iyad S. Ali ,&nbsp;Rachel M. Danforth ,&nbsp;Carla S. Fisher ,&nbsp;Mary E. Lester ,&nbsp;Aladdin H. Hassanein","doi":"10.1016/j.bjps.2025.03.056","DOIUrl":"10.1016/j.bjps.2025.03.056","url":null,"abstract":"<div><div>Ptosis can be a relative contraindication to nipple sparing mastectomy (NSM). Although a mastopexy-type approach can be performed during mastectomy, this requires very well perfused skin flaps and possibly intraoperative adjustments with the oncological breast surgeon. The purpose of this study is to assess risk factors that result in the nipple surgically raised secondarily in standard NSM with prepectoral tissue expander (TE) reconstruction to help guide surgical decision-making and patient counseling.</div><div>Patients at our center who underwent NSM and immediate prepectoral TE reconstruction were assessed. Patients who had immediate nipple position adjustment during the day of the mastectomy were excluded. Patients were divided into two groups: Group 1 (secondary nipple adjustment during the second stage) and Group 2 (no secondary nipple adjustment). Preoperative sternal notch-to-nipple distance, Regnault classification ptosis grade, brassiere size, and mastectomy weights were assessed.</div><div>The study included 158 patients: 33 patients in Group 1, 125 patients in Group 2. Grade II ptosis was present in 84.8% (28/33) of Group 1 compared to 58.4% (73/125) of Group 2 (p=0.0044). The average preoperative sternal notch-to-nipple distance for Group 1 was 26.2±2.6 cm compared to 24.7±3.9 cm for Group 2 (p=0.002). There was no difference in preoperative cup size between groups (p=1). The average mastectomy weight in Group 1 was 542.6±207.6 g compared to 449.4±264.3 g (p=0.03).</div><div>Patients with grade II ptosis, sternal notch-to-nipple &gt;26 cm, and larger breast size who undergo standard NSM are more likely to require secondary nipple correction. The findings can improve patient counseling and expectations.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 11-14"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of NovoSorb Biodegradable Temporising Matrix use over a 12-month period, with a focus on reconstructive salvage after free flap failure illustrated by a short case series","authors":"William Tsang ,&nbsp;Lincoln Saito Millan ,&nbsp;Daniel Williams ,&nbsp;Drew Cronin ,&nbsp;Dilip Gahankari ,&nbsp;Raja Sawhney ,&nbsp;Yezen Sheena","doi":"10.1016/j.bjps.2025.02.028","DOIUrl":"10.1016/j.bjps.2025.02.028","url":null,"abstract":"<div><div>We present a retrospective, cross-sectional review of 12 patients who underwent surgical reconstruction with NovoSorb® Biodegradable Temporising Matrix (BTM) over 1 year for trauma, cancer resection, necrotising fasciitis and chronic wounds. We report an overall success rate of BTM in 83% of cases. Three key cases are described in detail to show how BTM was successfully used as a means of reconstructive salvage after total or partial free flap failures for circumferential soft tissue defects that might otherwise have required a second free flap or limb amputation. The indications for BTM in non-burns wound closure are growing and our experience demonstrates it can provide a reliable ‘salvage’ reconstruction where traditional free flaps have failed and further tissue transfer is judged to have a poor risk-benefit ratio. We highlight BTM as an increasingly versatile tool in the armamentarium of reconstructive surgeons faced with challenging wounds including in the failed free flap setting and encourage further research on these advanced applications.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"103 ","pages":"Pages 396-403"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost and insurance coverage for reduction mammoplasty: Evidence from United States claims data","authors":"Nargiz Seyidova,&nbsp;Ivory Fu,&nbsp;Olachi Oleru,&nbsp;Amanda Walsh,&nbsp;Peter J. Taub","doi":"10.1016/j.bjps.2025.01.029","DOIUrl":"10.1016/j.bjps.2025.01.029","url":null,"abstract":"<div><h3>Background</h3><div>Despite the proven benefits of reduction mammoplasty, the procedure is often denied by insurance plans even when deemed medically beneficial. The present study sought to evaluate nationwide variation in insurance type coverage, as well as out of pocket and total costs for reduction mammoplasty in outpatient settings.</div></div><div><h3>Methods</h3><div>The Truven MarketScan Database was analyzed to identify patients who underwent reduction mammaplasty (CPT 19318) in an outpatient setting in 2021. Total and out-of-pocket (OOP) expenses, as well as cost variation between the regions and insurance plan types were assessed. Univariate parametric analysis was applied to evaluate the variation in financial variables.</div></div><div><h3>Results</h3><div>In total, 8660 patients underwent reduction mammoplasty. The overall median OOP cost was $523 (IQR $1548) and total payment cost was $8097 (IQR $8245). OOP medians did not vary by region (p=0.016) but varied by insurance type (p&lt;0.001) with the highest cost paid with high-deductible health plan (HDHP) ($1164, IQR $2196) and lowest with point of service with capitation (CPOS) ($25, IQR $852). For total cost expenses, there was statistical significance for region and plan type (p&lt;0.001). With the highest median total costs in Northeast region ($11023, IQR $11324) and point of service (POS) ($9923, IQR $11536).</div></div><div><h3>Conclusion</h3><div>Patients undergoing reduction mammoplasty may incur high OOP costs with a HDHP plan. Although out-of-pocket cost did not vary by region, it varied with the insurance type. Insurance companies are becoming increasingly involved in determining the medical necessity of surgical procedures and should be aware of the financial burden placed on patients.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"103 ","pages":"Pages 389-395"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based artificial intelligence: Implementing retrieval-augmented generation models to enhance clinical decision support in plastic surgery","authors":"Berk B. Ozmen ,&nbsp;Piyush Mathur","doi":"10.1016/j.bjps.2025.03.053","DOIUrl":"10.1016/j.bjps.2025.03.053","url":null,"abstract":"<div><div>The rapid advancement of large language models (LLMs) has generated significant enthusiasm within healthcare, especially in supporting clinical decision-making and patient management. However, inherent limitations including hallucinations, outdated clinical context, and unreliable references pose serious concerns for their clinical utility. Retrieval-Augmented Generation (RAG) models address these limitations by integrating validated, curated medical literature directly into AI workflows, significantly enhancing the accuracy, relevance, and transparency of generated outputs. This viewpoint discusses how RAG frameworks can specifically benefit plastic and reconstructive surgery by providing contextually accurate, evidence-based, and clinically grounded support for decision-making. Potential clinical applications include clinical decision support, efficient evidence synthesis, customizable patient education, informed consent materials, multilingual capabilities, and structured surgical documentation. By querying specialized databases that incorporate contemporary guidelines and literature, RAG models can markedly reduce inaccuracies and increase the reliability of AI-generated responses. However, the implementation of RAG technology demands rigorous database curation, regular updating with guidelines from surgical societies, and ongoing validation to maintain clinical relevance. Addressing challenges related to data privacy, governance, ethical considerations, and user training remains critical for successful clinical adoption. In conclusion, RAG models represent a significant advancement in overcoming traditional LLM limitations, promoting transparency and clinical accuracy with great potential for plastic surgery. Plastic surgeons and researchers are encouraged to explore and integrate these innovative generative AI frameworks to enhance patient care, surgical outcomes, communication, documentation quality, and education.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"104 ","pages":"Pages 414-416"},"PeriodicalIF":2.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “How to increase the success rate in microsurgical free and pedicled flap reconstructions with intraoperative multistep ICG imaging: A case series with 400 consecutive cases” [J Plast Reconstr Aesthet Surg 97 (2024) 147–155]","authors":"Tania Panettella ,&nbsp;Matteo Meroni ,&nbsp;Mario F. Scaglioni","doi":"10.1016/j.bjps.2025.03.047","DOIUrl":"10.1016/j.bjps.2025.03.047","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"104 ","pages":"Pages 339-341"},"PeriodicalIF":2.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative assessment of the velopharyngeal structures between children with repaired cleft palate and noncleft population using 3-dimensional magnetic resonance imaging","authors":"Etkin Boynuyogun ,&nbsp;Fırat Atak ,&nbsp;Ayca Karaosmanoglu ,&nbsp;Figen Ozgur","doi":"10.1016/j.bjps.2025.03.052","DOIUrl":"10.1016/j.bjps.2025.03.052","url":null,"abstract":"<div><div>Improved knowledge of normal velopharyngeal data and comparison with matched groups of children with repaired cleft palate are critical for understanding anatomical variability and the goals of surgery. The present study was designed to examine the differences in velopharyngeal structures between pediatric patients with repaired cleft palate and noncleft participants. Velopharyngeal variations were further analyzed by sex, cleft type, timing of cleft palate repair, and velopharyngeal insufficiency status in the pediatric population with cleft palate. A retrospective review was performed of pediatric patients undergoing magnetic resonance imaging (MRI) of the velopharynx between November 2020 and June 2023. Palatal and velopharyngeal measurements were obtained from the MRI scans. A total of 96 participants, aged 5–12 years, undergoing velopharyngeal evaluation with MRI were recruited: 48 participants with normal speech and without cleft palate and 48 patients with repaired cleft palate. The mean age of the noncleft group was 8.5 ± 2.3 and that of the cleft group was 6.4 ± 1.4. There was a statistically significant difference between cleft and noncleft participants in all variables (p &lt; 0.001). Velopharyngeal and palatal measures of patients with repaired cleft palate revealed significant inadequacies compared with noncleft participants, with divergence between the different cleft types. These findings can be used as a reference for future comparisons in research that uses similar variables in the cleft population.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 15-22"},"PeriodicalIF":2.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional facial soft-tissue changes after L-shaped reduction malarplasty: A pilot retrospective study","authors":"Xiaoshuang Sun ,&nbsp;Yiyuan Wei ,&nbsp;Hamza Younis ,&nbsp;Zihang Zhou ,&nbsp;Han Ge ,&nbsp;Jihua Li","doi":"10.1016/j.bjps.2025.03.051","DOIUrl":"10.1016/j.bjps.2025.03.051","url":null,"abstract":"<div><h3>Purpose</h3><div>Reduction malarplasty (RM) is a common facial contouring aesthetic procedure in East Asia. However, there is a lack of data on the postoperative changes in soft tissue and patient-reported outcomes. This retrospective study aimed to evaluate the soft-tissue changes and surgical outcomes following L-shaped RM.</div></div><div><h3>Methods</h3><div>Fifty-five patients who underwent L-shaped RM were enrolled and 55 patients who underwent genioplasty were enrolled as controls. The soft-tissue changes in relation to the underlying skeletal tissue were analyzed using computed tomography (CT) and three-dimensional (3D) stereophotogrammetry images. Patient’s satisfaction and surgical outcomes were investigated using the FACE-Q and Wrinkle Severity Rating Scale (WSRS).</div></div><div><h3>Results</h3><div>In the RM group, the soft tissue in zygoma (S2), zygomatic arch (S3), and upper cheek (S5) regions showed a significant inward reduction postoperatively (<em>p</em>&lt;0.001), while the paranasal region (S4) showed a significant outward augmentation (<em>p</em>&lt;0.001). Compared with the control group, the postoperative soft-tissue changes in S2, S3, S4, and S5 demonstrated significant differences in the RM group (<em>p</em>&lt;0.001). The postoperative skeletal-tissue changes in the upper zygoma (B2), zygomatic arch (B3), and lower zygoma (B5) regions exhibited a significant decrease (<em>p</em>&lt;0.001). Significant correlation was observed between the soft and hard tissue changes in B2, B3, and B5 regions (<em>p</em>&lt;0.001). Additionally, patients demonstrated significant postoperative improvement in satisfaction with appearance, although 6 patients’ WSRS grade increased by one-grade.</div></div><div><h3>Conclusion</h3><div>Following RM, the soft tissue in surgical regions showed inward depression, while the paranasal soft tissue protruded outward, indicating that the soft tissue exhibited a certain degree of sagging. Although the severity of nasolabial folds increased in some patients, the patient’s self-evaluation of aesthetics remained unaffected. The findings suggest that surgeons should consider skeletal and soft-tissue changes when planning RM, and patients should also be informed about the potential postoperative soft-tissue changes to effectively manage their expectations.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 3-10"},"PeriodicalIF":2.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Immediate lymphatic reconstruction with targeted lymphatic axillary repair\" by Pons et al.","authors":"Mohammad R. Goodarzi,&nbsp;John M.D. Henton,&nbsp;Daniel Saleh,&nbsp;Chad Chang","doi":"10.1016/j.bjps.2025.02.054","DOIUrl":"10.1016/j.bjps.2025.02.054","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"104 ","pages":"Pages 386-387"},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abductor digiti minimi opponensplasty and flexor digitorum superficialis opposition transfer: What are the main indications? A literature review","authors":"Veronica Fasoli ,&nbsp;Chiara Parolo ,&nbsp;Leonardo Garutti ,&nbsp;Annachiara Tellarini ,&nbsp;Giulia Del Vecchio ,&nbsp;Luigi Antonio Valdatta ,&nbsp;Giorgio Eugenio Pajardi","doi":"10.1016/j.bjps.2025.02.035","DOIUrl":"10.1016/j.bjps.2025.02.035","url":null,"abstract":"<div><div>Thumb hypoplasia is a rare deformity of the hand. Type II and IIIA are the main indications for opponensplasty, together with thumbs with a residual weak opposition after pollicization. Our study operates a review of the current literature to establish which opponensplasty technique is the most appropriate for each patient. We conducted a systematic search using PubMed, Embase, and Web of Science databases. The keywords used were “thumb hypoplasia,” AND “opponensplasty,” “abductor digiti minimi opponensplasty,” “thumb hypoplasia,” AND “abductor digiti minimi,” “opponensplasty,” AND “hypoplasia,” “flexor superficialis opponensplasty,” “flexor digitorum superficialis opponensplasty.” A minimum of 1 year of follow-up was required for inclusion. A total of 222 studies were recovered, of which only 9 articles satisfied our inclusion criteria. From the results obtained, the choice between abductor digiti minimi opponensplasty and flexor digitorum superficialis transfer should depend on the severity of the deformity and the main goal that should be achieved. Children with type IIIA hypoplasia characterized by more unstable joints should undergo flexor digitorum superficialis transfer to restore joint stability. On the contrary, when the instability is not of great concern, abductor digiti minimi opponensplasty, which aims at better defining the thenar eminence and restoring a better global hand function, should be preferred.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 34-40"},"PeriodicalIF":2.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing digital anthropometry in plastic surgery: Comparing smartphone 3D surface imaging to Vectra H2 in breast reconstruction","authors":"Nikolas Chrobot ,&nbsp;Michael Alfertshofer ,&nbsp;Konstantin Frank ,&nbsp;Wenko Smolka ,&nbsp;Alexandra Anker ,&nbsp;Juergen Taxis ,&nbsp;Tobias Ettl ,&nbsp;Lukas Prantl ,&nbsp;Vanessa Brébant ,&nbsp;Robin Hartmann","doi":"10.1016/j.bjps.2025.03.039","DOIUrl":"10.1016/j.bjps.2025.03.039","url":null,"abstract":"<div><h3>Background</h3><div>Digital anthropometry is a useful tool for surgeons and patients in breast reconstruction surgery (BRS). Owing to advancements in smartphone technology, these devices can be used for three-dimensional (3D) surface imaging. In this prospective study, anthropometric measurements of the breast were performed using a smartphone and compared with measurements obtained using an established 3D surface imaging system.</div></div><div><h3>Methods</h3><div>In this study, 40 patients who underwent BRS were included. 3D-surface models (SMs) were obtained using the Vectra H2 stereophotogrammetry camera (Canfield Scientific, USA) and an iPhone 15 (Apple Inc., USA) in combination with the 3D Scanner App (Laan Consulting Corp., USA). Fourteen measurements were performed on all 3D SMs. Subsequently, smartphone-based measurements were compared to Vectra-based measurements. Statistical methods used were the paired t-test, paired Wilcoxon-signed ranks test, Bland–Altman analyses, and calculation of the intraclass correlation coefficient (ICC).</div></div><div><h3>Results</h3><div>All measurements demonstrated excellent agreement between those obtained using the smartphone and Vectra H2 (ICC between.963 and.998). No statistical differences were found for 11 of the 14 anthropometric measurements. The Bland–Altman analyses yielded promising results, demonstrating 95% limits of agreement within a range of less than ±2 mm between the 2 methods.</div></div><div><h3>Conclusion</h3><div>The proposed method for smartphone-based anthropometry of the breast showed moderate accuracy for clinical use. However, the approach used to create and evaluate the 3D SMs is considered laborious. Therefore, further refinement of the method may be necessary to enable the implementation of smartphone-based surface imaging in plastic surgery.</div></div><div><h3>Clinical trial registration number</h3><div>DRKS00034221.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"104 ","pages":"Pages 398-406"},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}