Annals of Plastic Surgery最新文献

{"title":"The Modified Frailty Index Predicts Outcomes in Immediate Implant-Based Breast Reconstruction.","authors":"Dora Danko, Makenna E Ash, Albert Losken, Peter W Thompson","doi":"10.1097/SAP.0000000000004249","DOIUrl":"10.1097/SAP.0000000000004249","url":null,"abstract":"<p><strong>Background: </strong>Risk stratification is a crucial tool to help in surgical planning and counseling. Historically, this has been measured by age, BMI, smoking status, or medical comorbidities. Frailty, the combined burden of the patient's comorbidities and risk factors, has gained traction as a method of combining disparate risk factors into one number. The modified 5-factor frailty index (mFI-5) is simple to calculate and takes only moments to assign a risk level to a patient.</p><p><strong>Objectives: </strong>This study aimed to study the application and efficacy of the mFI-5 as a measurement of operative risk in immediate breast reconstruction.</p><p><strong>Methods: </strong>A total of 650 patients undergoing breast reconstruction at our institution were identified. Patients were divided into 5 mFI-5 groups based on their associated comorbidities. Surgical outcomes were compared using the χ 2 or Fisher exact tests for categorical variables and t tests for continuous variables.</p><p><strong>Results: </strong>There were 452 patients stratified into the mFI-5 0 group, 155 patients into the mFI-5 1 group, 40 patients into the mFI-5 2 group, and 3 patients into the mFI-5 3 group. There were no patients in our cohort in either the mFI-5 4 or 5 groups. In comparison of the mFI-5 0 group to 1 group, there was a significant difference in postoperative day of infection (32.06 vs. 21.5 days. respectively; P = 0.049). When comparing to the mFI-5 2 group, there was a significant difference in overall complications on univariate analysis ( P = 0.012), minor infections on univariate and multivariate analysis ( P = 0.050 and P < 0.001), seroma formation on univariate analysis ( P = 0.017), hematoma formation ( P < 0.001), return to OR ( P < 0.001), and replaced implant ( P < 0.001) on multivariate analysis. When comparing the mFI-5 1 group to the mFI-5 2 group, there was a significant difference between overall complications on both univariate and multivariate analyses ( P = 0.012 and P = 0.041) and minor infections on univariate analysis ( P = 0.032).</p><p><strong>Conclusions: </strong>The modified 5-factor frailty index is effective in predicting increased complication risks seen after IBR and may be helpful for surgeons when counseling patients and assessing overall operative risk.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"426-432"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frozen Section Mohs: A Hybrid Technique and One Plastic Surgeon's Experience With 1714 Consecutive Skin Cancer Removals.","authors":"Michael L Chang, Steven L Chang, Fady Gerges, Matthew M Delancy, Amanda C Yang, Lawrence D Chang","doi":"10.1097/SAP.0000000000004254","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004254","url":null,"abstract":"<p><strong>Abstract: </strong>While US nonmelanoma skin cancer (NMSC) mortality rate has decreased in the past decade, its incidence is rising. Traditional surgical treatments include wide local excision, intraoperative frozen section analysis (IFSA), and Mohs micrographic surgery (MMS). IFSA and MMS are techniques that provide intraoperative analysis allowing the surgeon to confirm margins clear of malignancy and minimize tissue damage, especially in cosmetically sensitive subunits. MMS, with cure rates up to 99%-100%, is considered the gold standard but is limited geographically and financially because of specialized training. We report a hybrid surgical technique that effectively excises cutaneous malignancy but can be utilized by plastic surgeons. This hybrid technique is called frozen section Mohs (FSM), which combines both techniques utilized in IFSA and MMS. FSM is similar to IFSA in that the middle breadloaf visualizes the central deep margin but is similar to MMS in that the entire periphery is also analyzed. This paper is a retrospective review of all patients who have undergone the FSM procedure by one plastic surgeon from September 2017 to June 2023. The primary outcomes were 1) recurrence, determined by excision of skin cancer demonstrated to be arising from postexcision scar tissue, and 2) concordance between intraoperative and final pathology. There were 1714 FSM procedures performed with a cohort averaging 73.8 years old and 57% male. Zero recurrences were identified (100% cure rate). Two cases (0.11%) were false negatives and the patients returned for re-excision. About 48.2% of cases were basal cell carcinoma while 40.7% were squamous cell carcinoma. The average number of stages per FSM procedure was 1.17. The mean defect size was 1.83 cm.2 Complication rate was 2.28% (n = 39), with the most common issue being bleeding that required suturing or cautery. Our proposed FSM technique's results demonstrate effective carcinoma removal comparable to MMS. Plastic surgeons may therefore utilize this technique to meet the growing demands of skin cancer surgery in the United States with equally effective outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S121-S125"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polylactic Acid Membrane for the Treatment of Pediatric Burn Injuries: An Adoptable Practice to Improve Burn Management.","authors":"Brielle E Raine, Cody C Fowler, Antoinette Nguyen, Piper Schneider, Kiernan J Gunn, Rishika Chikoti, Derek E Bell","doi":"10.1097/SAP.0000000000004261","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004261","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Polylactic acid membrane (PLAM) is a one-time application alloplastic skin substitute that has been utilized as an adjunct for pediatric burns for a multitude of indications. Literature has established its utility in mixed superficial and deep dermal burns, with advantages related to decreased need for procedures requiring general anesthesia and decreased overall healthcare cost (Eur Burn J 2021;3(1):1-9). Additionally, its application has been comparable in wound healing outcomes to established standard of care practices (Burns 2023;49(7):1585-1591, Wound Repair Regen 2006;14(3):321-4). Our study analyzes the impact of integrating PLAM into pediatric burn management at a single burn center. We hypothesize that the integration of PLAM into our practice would result in improved outcomes related to wound care needs, surgical efficiency, hospital length of stay, and overall wound healing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective study of all pediatric (&lt;18 years of age) patients with second- and third-degree burns treated at a single American Burn Association (ABA)-verified pediatric burn center from December 2019 to April 2024. All burn etiologies were included, and isolated first-degree burns were excluded. Our retrospective cohort was separated into two distinct treatment periods (pretherapy Era 1 and posttherapy Era 2) based on time before and after the introduction of PLAM at our institution (March 1, 2022). Data on patient demographics, burn characteristics, hospitalization treatments, operative details, surgical outcomes, and time to wound healing were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 331 pediatric patients met the inclusion criteria. A total of 155 patients were included in our pretherapy Era 1 and 176 patients in our posttherapy Era 2. The average age was 5.6 years old, and the majority of patients were male (62.2%) and White (55.0%). Baseline characteristics between our two cohorts were comparable across age, gender, race, ethnicity, BMI, mechanism of burn, and total body surface area (TBSA) burned. The need for sedated burn care significantly decreased after the introduction of PLAM (72.9% vs 59.4%, P = 0.010), and the average number of days of sedation decreased as well (3.7 vs 2.1 days, P &lt; 0.001). Forty-one percent of all patients underwent surgical intervention for their burns with a significant increase in the number of patients receiving surgery in the posttherapy era (32.9% vs 48.3%, P &lt; 0.001). Additionally, time from burn to surgery shortened in Era 2 (9.1 vs 7.2 days, P &lt; 0.001). There was a statistically significant reduction in median procedure time in Era 2 (26 vs 13 minutes, P &lt; 0.001). Finally, we observed significant reductions in median length of hospital stay (5 vs 4 days, P = 0.004), postoperative length of stay (1 vs 0 days, P = 0.017), the need for sedated postoperative dressing changes (54.9% vs 18.8%, P &lt; 0.001), and need for home nursing visits","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S218-S222"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Chart Review Efficiency in Pressure Injury Evaluation Using ChatGPT.","authors":"Rebecca Friedman, Rebecca Lisk, Katherine Cordero-Bermudez, Soniya Singh, Sofia Ghani, Brian M Gillette, Scott A Gorenstein, Ernest S Chiu","doi":"10.1097/SAP.0000000000004275","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004275","url":null,"abstract":"<p><strong>Introduction: </strong>Wound care is an essential discipline in plastic surgery, especially as the prevalence of chronic wounds, such as pressure injuries, is increasing. The escalating volume of patient data and the numerous variables influencing wound outcomes are making traditional manual chart reviews in wound care and research increasingly complex and burdensome. The emergence of Natural Language Processing (NLP) software based on large language models (LLMs) such as ChatGPT presents an opportunity to automate the data extraction process. This study harnesses the capabilities of ChatGPT, hosted by our medical center's secure, private Azure OpenAI service, to automatically extract and process variables from patient charts following sacral wound visits. We assess ChatGPT's potential to revolutionize chart review through improved data retrieval accuracy and efficiency.</p><p><strong>Methods: </strong>We evaluated the use of the medical center's internal ChatGPT in chart review. ChatGPT and a Python script were integrated into the existing chart review process for patients with sacral wounds from 2 hospital cohorts to extract and format variables related to wound care. Metrics include time taken for review, accuracy of extracted information, and assessment of ChatGPT-generated insights.</p><p><strong>Results: </strong>ChatGPT reduced the average time per chart review from 7.56 minutes with the manual method to 1.03 minutes using ChatGPT. Furthermore, it achieved a 0.957 overall accuracy rate compared to manual chart review, ranging from 0.747 to 0.986 across extracted data elements. ChatGPT was also able to synthesize accurate narrative descriptions of patient wounds.</p><p><strong>Conclusions: </strong>We highlight ChatGPT's potential to enhance speed and precision of chart review in the context of both clinical care and wound care research, offering valuable implications for integration of artificial intelligence in healthcare workflows.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S327-S333"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Platelet-Rich Plasma and Platelet-Rich Fibrin in Facial Rejuvenation.","authors":"Nancy Qin, Makayla Kochheiser, Izzet Akosman, David Dugue, Alex Raghunandan, Chetan Pavuluri, Carson Gundlach, Anna M Vaeth, Lucy Wei, Benjamin R Wesorick, David M Otterburn","doi":"10.1097/SAP.0000000000004267","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004267","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are promising treatments for facial rejuvenation, leveraging growth factors to stimulate natural tissue repair and regeneration. Despite their growing popularity, their effectiveness remains controversial, with studies yielding mixed results. This systematic review evaluates the current evidence on PRP/PRF therapies and their effect on the following 6 key parameters of facial aging: wrinkles, texture, dyschromia, elasticity, skin thickness, and hydration.</p><p><strong>Methods: </strong>A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases for controlled trials, prospective cohort studies, and case series published after 2010. Eligible studies included more than 5 patients, evaluated PRP or PRF as monotherapy, and addressed at least 1 of the 6 listed parameters of facial aging. Articles were screened by 2 independent investigators and scored for quality of evidence using the Oxford Centre for Evidence-Based Medicine hierarchy.</p><p><strong>Results: </strong>Twenty articles, comprising 514 patients, met inclusion criteria. Sixteen studies compared PRP/PRF to a control or baseline, while 4 compared them to alternative treatments. Wrinkles and fine lines (n = 16) were the most frequently studied parameters, followed by dyschromia (n = 12), texture (n = 11), elasticity (n = 6), skin thickness (n = 5), and hydration (n = 4). Significant improvements following PRP/PRF treatment were reported in 80% of studies on skin thickness, 75% on elasticity, 40% on wrinkles, 33% on texture, 17% on dyschromia, and 0% on hydration. Skin dyschromia had the highest proportion of studies reporting mixed findings (41.7%), whereas skin hydration had the highest proportion of studies reporting no improvement (67%). Additionally, all studies evaluating patient satisfaction reported significant improvements from pretreatment to posttreatment. No serious adverse events were reported in any of the included studies.</p><p><strong>Conclusions: </strong>This systematic review identified skin thickness and elasticity as the facial aging parameters with the strongest evidence of improvement following PRP/PRF treatment, while skin hydration showed the weakest.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S376-S389"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Modified Fragility Index and Perioperative Albumin as Predictors of Complications in Complex Abdominal Wall Reconstruction.","authors":"Makenna Ash, Troy Marxen, Shannon Su, Albert Losken","doi":"10.1097/SAP.0000000000004316","DOIUrl":"10.1097/SAP.0000000000004316","url":null,"abstract":"<p><strong>Background and significance: </strong>Complex abdominal wall reconstruction (CAWR) is performed to restore the structure and function of the abdominal wall. These procedures carry the risk of complications such as delayed wound healing, skin necrosis, infection, recurrence, or even death. The 5-factor modified fragility index (5-mFI) has gained popularity as a concise method of evaluating preoperative risk across various surgical specialties. Additionally, perioperative hypoalbuminemia has been previously associated with delayed wound healing after surgery. The purpose of this study was to assess the utility of the 5-mFI in combination with perioperative albumin levels for assessing risk in complex abdominal wall reconstruction.</p><p><strong>Methods: </strong>This was a retrospective, single-institution chart review study of all patients who underwent CAWR by the senior author (A.L.) from 2002 to 2023. Demographics, comorbidities, details of surgery, perioperative albumin levels, ASA scores, and complications were collected for each patient. Five-factor modified fragility indices were calculated for each patient. Statistical analysis consisted of χ 2 and Fisher exact tests for categorical variables, t tests for continuous variables, and multivariate analysis.</p><p><strong>Results: </strong>Our analysis included 437 patients. The average age of our patients was 54.3 years, the average BMI was 32.1 kg/m 2 , and the average length of follow-up with the plastic surgery service was 264 days. A total of 118 (27.0%) developed complications, with the most common complications being delayed wound healing (89 patients, 20.4%) and infection (78 patients, 17.8%). Other complications included skin necrosis, fistula formation, hematoma, seroma, infection, and death. Sixty patients (13.7%) experienced recurrence of their hernias within the follow-up period. An mFI of 2 or greater was significantly associated with delayed wound healing (LR, 11.42; P = 0.0436) as well as skin necrosis (LR, 4.826; P = 0.028). The presence of an mFI of 2 or greater and perioperative hypoalbuminemia was significantly associated with development of major complications (LR, 3.221; P = 0.0457), delayed wound healing (LR, 5.999; P = 0.0143), skin necrosis (LR, 9.19; P = 0.0024), and mortality (LR, 5.287; P = 0.0215). On multivariate analysis, the presence of an mFI of 2 or greater when combined with perioperative hypoalbuminemia was found to be independently associated with mortality (LR, 1524.5; P < 0.0001).</p><p><strong>Conclusions: </strong>We found the 5-factor mFI to be significantly associated with delayed wound healing and skin necrosis in our patient population. When an mFI of 2 or greater was present along with perioperative hypoalbuminemia, patients were significantly more likely to experience complications, issues with wound healing, and mortality. Surgeons should take these findings into account when counseling patients preoperatively.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"457-461"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Delays to Lower Extremity Free Flap Reconstructions.","authors":"Kristina L Khaw, Monica Morgenstern Berkman, Steven C Bonawitz","doi":"10.1097/SAP.0000000000004221","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004221","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity flap reconstructions are often due to traumatic injuries requiring emergency surgeries. Studies found that delays to operating increase morbidity, mortality, and length of hospital stay. There are limited studies assessing disparities in delays to reconstruction. This study investigates factories correlated to delays in surgery in lower extremity reconstructions.</p><p><strong>Methods: </strong>In a single center from January 2015 to January 2024, 80 patients who underwent a lower extremity flap reconstruction and remained inpatient until their reconstruction operation were identified. The time to surgery from admission, time to consult, and time from consult to surgery were collected. Delays to flap were defined as >14 days from admission to surgery. Demographics, substance use history, Charlson Comorbidity Index, and Trauma Severity Score were collected. A multiple analysis of variance for quantitative variables and a χ2 test for categorical variables were conducted. Variables with significant values on univariate analysis were further analyzed using a multivariate logistic regression to account for confounding variables.</p><p><strong>Results: </strong>In the delay to flap (DF) cohort (n = 40) and no delay to flap (ND) cohort (n = 40), minority patients were more likely to experience delays to flap (P < 0.001). Surprisingly, there were no correlations to Charlson Comorbidity Index, Trauma Severity Score, marijuana, or illegal drug use. ND patients were more likely to have a history of tobacco use (P = 0.012). DF patients correlated with a significantly longer time to consult (DF: 8.1 d, ND: 2.3 d, P < 0.001) and time to surgery from consult (18.3 d, 5.8 d, P < 0.001). There was a significant correlation between DF and preoperative infection (P = 0.012). DF patients were significantly associated with hypertension (P = 0.030) and less likely to have gastroesophageal reflux disease (P = 0.032). Of significant factors, hypertension was significantly associated with complications (P = 0.037).</p><p><strong>Conclusions: </strong>Patients who experience delays to flap were more likely to be a minority, have preoperative infections, delayed time to consult, and hypertension. Although postoperative infection was correlated with ND, DF patients were associated with preoperative infections. This suggests that there may be a disparity of infection management, susceptibility to infection, and flap recognition that lead to delays to lower extremity reconstruction. Larger prospective studies may be helpful to further evaluate reasons for delays.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S155-S159"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Operative Plane on Anesthetic Requirements in Tissue Expander Breast Reconstruction Patients.","authors":"Christina S Chopra, Jason Chen, Syed Shah, Tara L Huston","doi":"10.1097/SAP.0000000000004256","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004256","url":null,"abstract":"<p><strong>Background: </strong>Initially subpectoral, the plane of choice for tissue expander placement in breast reconstruction has evolved over the past decade, with more surgeons moving to prepectoral placement. In making this transition, our institution noted a subjective decrease in the anesthetic requirements of patients undergoing the second stage of their prepectoral reconstruction. Despite this, there is little published literature on the topic. Therefore, our study aims to examine the differences in anesthetic requirements among patients with subpectoral versus prepectoral expanders at the time of exchange to permanent implants.</p><p><strong>Methods: </strong>We conducted a single-surgeon retrospective chart review of all patients undergoing breast reconstruction with tissue expanders from 2017 to 2024. We compared patients with prepectoral tissue expanders to those with subpectoral tissue expanders. Variables collected included perioperative pain medications, sedatives, muscle relaxers, antiemetics, reversal agents, and local anesthetics. Additional data were collected on steroids, diabetes, and hypertension medications and antibiotics used.</p><p><strong>Results: </strong>A total of 251 patients met the criteria for evaluation, 71 subpectoral and 180 prepectoral. We found that subpectoral patients averaged a statistically significantly higher requirement of fentanyl and hydromorphone in the perioperative period. This group also had a significantly higher requirement of reversal agent and supplementary antiemetic medications. Other medications including those to manage infection, blood pressure, secretions, deep sedation, and awakening did not vary between groups.</p><p><strong>Conclusions: </strong>We found that patients with prepectoral tissue expanders undergoing exchange to permanent implants have decreased perioperative requirements of pain and antiemetic medications. Although the operative plane of choice in breast reconstruction is a multifaceted decision, we demonstrate that the prepectoral plane results in decreased pain medication burden in the perioperative period. Our study is the first to quantify these differences, allowing evidence-based decisions for patients and physicians.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S126-S127"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Breast Implant Screening Guidelines in Breast Cancer Reconstruction.","authors":"Meeti Mehta, Casey Zhang, Shayan Sarrami, Vanessa Mroueh, Carolyn De La Cruz","doi":"10.1097/SAP.0000000000004329","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004329","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, the US Food and Drug Administration updated its surveillance recommendations for breast implant rupture to ultrasound screening or magnetic resonance imaging (MRI) 5-6 years following silicone implant placement, with repeat screening every 2-3 years thereafter. This study evaluates the risk of implant rupture and assesses the utility of routine surveillance MRIs in diagnosing implant rupture.</p><p><strong>Methods: </strong>We performed a retrospective review of patients with implant-based reconstruction for breast cancer with a single surgeon between 2012 and 2017. Inclusion criteria included a 5-year minimum follow-up period. Analysis was performed to elucidate rupture rate and associated factors.</p><p><strong>Results: </strong>A total of 376 patients underwent reconstruction with saline (13%) and silicone implants (87%). Seventy-five (20%) underwent routine MRI screening within 5-6 years of surgery. Implant rupture occurred in 26 patients (7%). Average time from implant placement to rupture was 5.9 ± 4.0 years. Fifty-nine percent of silicone implant ruptures were diagnosed by MRI screening. Thirty-eight percent of silicone implant ruptures presented without clinical symptoms and were identified on routine MRI screening. All saline implant ruptures presented with clinical symptoms. On imaging, ruptures were classified as intracapsular (81%) or extracapsular (12%). Seventy-three percent of ruptures were confirmed intraoperatively during implant replacement. Median time for rupture diagnosis to implant removal/replacement was 3 months (range, 0.5-21 months).</p><p><strong>Conclusions: </strong>MRI screening for silicone implant rupture in implant-based breast reconstruction had a 59% detection rate, with relatively low patient adherence (20% within 5-6 years after surgery), highlighting the challenges of screening. Patients should be counseled on the risk of implant rupture and the likelihood of needing replacement during their lifetime.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S173-S176"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor-to-Breast Volume Ratio and Outcomes After Oncoplastic Breast Conserving Surgery.","authors":"Casey Zhang, Alberto Vera, Kelly Murphy, Michael Calcaterra, Vanessa Mroueh, Hamid Alhmari, Carolyn De La Cruz, Michael L Gimbel, Vu T Nguyen, John Austin Vargo, Priscilla F McAuliffe, Brodie A Parent","doi":"10.1097/SAP.0000000000004288","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004288","url":null,"abstract":"<p><strong>Introduction: </strong>Oncoplastic breast conserving surgery (OBCS) can offer oncologically safe and cosmetically satisfying results for patients with breast cancer. However, the relative oncologic safety of high tumor-volume oncoplastic resections is largely unknown. This study investigated the association between tumor-to-breast volume ratio, recurrence, and surgical complications in OBCS. The relationship between tumor-to-breast ratio and quality of life was also assessed.</p><p><strong>Methods: </strong>A retrospective review was performed for all women who underwent OBCS for breast cancer between 2010 and 2023 at a university-based tertiary referral center. The BREAST-Q questionnaire was utilized to assess quality of life outcomes. Tumor-to-breast ratio was calculated by dividing lumpectomy specimen volume by total breast volume. Surgical complications, reexcision, local recurrence, and revision procedures were noted. Multivariate logistic regression was performed to assess the association of tumor-to-breast ratio with outcomes.</p><p><strong>Results: </strong>This study included 192 patients, of which 65 (34%) completed the BREAST-Q. Median tumor-to-breast volume ratio was 7.3% (IQR, 3.6%-12.5%). Quartiles of tumor-to-breast ratio were not associated with local cancer recurrence rate (P = 0.50), reexcision (P = 0.29), wound-related complications (P = 0.45), complications requiring reoperation (P = 0.34), and elective revision of reconstruction (P = 0.67). BREAST-Q scores for Psychosocial Well-being, Physical Well-being, and Overall Satisfaction were similar across tumor-to-breast ratio. Cancer worry was significantly higher in larger tumor-breast ratio quartiles (P = 0.03).</p><p><strong>Conclusions: </strong>These data suggest that OBCS is a reasonable approach for patients with higher tumor-to-breast ratio. Complications and quality of life metrics did not appear to vary significantly with increasing tumor size, except for \"cancer worry,\" which was higher among patients with larger tumor-breast ratio patients.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S297-S304"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}