Annals of Plastic Surgery最新文献

{"title":"Giant Condyloma Acuminatum: A Review of Reconstructive Options.","authors":"Brooke E Barrow, Kwadwo O Ansah, Hani I Naga, Nicklas Sarantos, Brant A Inman, Andrew C Peterson, Detlev Erdmann","doi":"10.1097/SAP.0000000000004349","DOIUrl":"10.1097/SAP.0000000000004349","url":null,"abstract":"<p><strong>Abstract: </strong>The management of giant condyloma acuminatum in the male population remains challenging given the anatomic complexity of this region. Preservation of micturition and sexual function are key considerations. After primary resection, reconstructive plastic surgery is often necessary for coverage of soft-tissue defects, necessitating a multidisciplinary approach by urologic, plastic, and colorectal surgery. Because of the rarity of this disease, a defined treatment protocol has not been established. This review aims to outline key considerations and reconstructive options for this challenging disease, which are highlighted by two cases of successful reconstruction.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6","pages":"695-700"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957789","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":"Financial Effect of Enhanced Recovery After Surgery in Autologous Breast Reconstruction.","authors":"Robert G DeVito, Benjamin G Ke, Kristen Stephens, Scott T Hollenbeck, Chris A Campbell, John T Stranix","doi":"10.1097/SAP.0000000000004391","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004391","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) pathways have become increasingly common in surgery, but the ERAS financial impact on autologous breast reconstruction has not been defined.</p><p><strong>Methods: </strong>This study performed a retrospective review of consecutive autologous breast reconstructions (July 2017 to June 2022; 264 patients, 156 pre-ERAS implementation and 108 post-ERAS implementation). Clinical outcomes included length of stay (LOS), ICU length of stay (ICU LOS), average daily morphine milligram equivalent (MME) use, and average total MME use. Financial metrics evaluated the total charges, total cost, direct cost, indirect cost, estimated reimbursement, and direct margin.</p><p><strong>Results: </strong>Average LOS was lower in the ERAS cohort (2.13 vs. 3.21 days, P < 0.001). Average ICU LOS was lower in the ERAS cohort (0.0 vs 0.75 days, P < 0.001). Total charges were lower in the ERAS cohort ($98,876 vs. $119,568, P < 0.001). Total cost was lower in the ERAS cohort ($25,725 vs. $30,972, P < 0.001). Direct cost was lower in the ERAS cohort ($15,900 vs. $18,823, P < 0.001). Indirect cost was lower in the ERAS cohort ($9825 vs. $12,149, P < 0.001). Estimated reimbursement was equivalent ($27,464 vs. $24,697, P = 0.14). Direct margin was higher in the ERAS cohort ($11,564 vs. $5874, P = 0.0015).</p><p><strong>Conclusions: </strong>ERAS pathways in autologous breast reconstruction decrease length of stay, ICU utilization, and improve financial metrics. Further investigations into quality improvements in ERAS warrant investigation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S549-S554"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207475","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":"Local Antibiotic Delivery Systems for Infection Prophylaxis in Implant-Based Breast Reconstruction: What Is the Evidence?","authors":"Francis D Graziano, Ronnie L Shammas, Babak J Mehrara, Danielle H Rochlin","doi":"10.1097/SAP.0000000000004416","DOIUrl":"10.1097/SAP.0000000000004416","url":null,"abstract":"<p><strong>Background: </strong>Infection is a major complication of implant-based breast reconstruction (IBBR), leading to implant loss, increased healthcare costs, and poor outcomes. Local antibiotic delivery systems offer targeted infection prevention by providing sustained antibiotic release at the surgical site. The aim of this study is to review the existing literature on the efficacy of local antibiotic delivery systems in preventing infection in IBBR.</p><p><strong>Methods: </strong>A systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted in Medline, Cochrane, and Embase (1990-2025). Studies assessing local antibiotic delivery in IBBR were included, while those evaluating systemic antibiotics, augmentation, and salvage procedures were excluded. Data on infection rates, implant loss, and complications were extracted and analyzed.</p><p><strong>Results: </strong>Of 163 identified articles, 6 met inclusion criteria. Two studies examined calcium sulfate biodegradable antibiotic beads, which significantly lower implant loss rates (1.6% vs 9.4%, P = 0.031 and 1.5% vs 11.9%, P = 0.024). Two studies on polymethylmethacrylate antibiotic plates showed significant SSI reduction from 12.6% to 4.8% (P < 0.01) and from 14% to 4% (P = 0.047), with implant loss rates significantly lower in polymethylmethacrylate cohort (6% vs 18%, P = 0.036). Continuous postoperative antibiotic irrigation studies demonstrated SSI reduction from 6.4% to 1.9% (P = 0.007) and decreased explant rate from 20% to 2.9% (P = 0.037), but one study reported a higher seroma rate (4.7% vs 1.4%, P = 0.033).</p><p><strong>Conclusions: </strong>Preliminary studies suggest local antibiotic delivery may reduce infection and implant loss in breast reconstruction, but retrospective designs and methodological limitations preclude definitive conclusions. Prospective studies are needed to confirm efficacy, safety, and clinical value.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"Reduction Mammaplasty: Closed Suction Drains Do Not Reduce Hematoma or Seroma But Increase Infection Risk\".","authors":"Majid Ismayilzade, Alper Buharalioglu, Batuhan Aysever, Halil Ibrahim Canter","doi":"10.1097/SAP.0000000000004402","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004402","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473835","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 Incomplete V-Y Flap: A Useful Design Modification of the Conventional V-Y Flap Exampled With a Case Series of Pilonidal Sinus Excision Defects.","authors":"Luke Conway, Emma Snashall, Joseph Wignall, Laura Cappuyns, Kayvan Shokrollahi","doi":"10.1097/SAP.0000000000004251","DOIUrl":"10.1097/SAP.0000000000004251","url":null,"abstract":"<p><strong>Abstract: </strong>Pilonidal disease is relatively common and can be particularly comorbid for patients, especially in circumstances of chronic abscess or sinus formation. Excision of such disease can require flap reconstruction, one of the most common types being V-Y advancement flap. We present a modification of the V-Y flap that leaves incompletely incised distal edges that theoretically will help to avoid flap tip necrosis while allowing sufficient tissue mobility. Five male patients underwent 7 operations to excise their pilonidal disease with reconstruction using the incomplete V-Y technique modification over a 4-year period. Two patients had further operations due to development of additional disease adjacent to the prior operating site. There were no incidents of wound dehiscence or flap tip necrosis. No admission was required for postoperative complications, and no revisional surgery was necessary. Subjectively, there were no issues raised by patients regarding scar appearance. This V-Y flap modification appears to be safe and reliable in terms of complication rate and flap tip preservation following pilonidal disease excision surgery. In addition, it does not compromise the ability to perform sufficient soft tissue cover in such cases.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"577-580"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623309","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":"A 13-Year Experience With a 3-Stage Dermal Regeneration Matrix Approach to Hand Burns.","authors":"Tiffany Jeong, Mario Alessandri-Bonetti, Jose Antonio Arellano, Hilary Y Liu, Sumaarg Pandya, Alain C Corcos, Jenny A Ziembicki, Guy Stofman, Francesco M Egro","doi":"10.1097/SAP.0000000000004206","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004206","url":null,"abstract":"<p><strong>Introduction: </strong>Dermal regeneration matrix (DRM) has been demonstrated to be safe and beneficial in improving functional outcomes for the management of acute hand burns. DRM followed by split thickness skin graft (STSG) allows for a 2-stage reconstruction for most operative hand burn injuries. Our site routinely implements a 3-stage approach: allograft in the first stage, DRM in the second stage, and STSG in the final stage. This study aims to compare the surgical and functional outcomes of 2-stage DRM reconstruction and 3-stage reconstruction.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to review surgical and functional outcomes of patients treated for hand burns. All patients seen from April 2009 to December 2022 with hand burns, who were managed surgically, were considered for the study.</p><p><strong>Results: </strong>A total of 227 patients were treated for hand burns between 2009 and 2023. Out of these, 183 met the inclusion criteria. Most patients were male (72.9%, n = 129) and had burns covering an average of 19.2 ± 19.4% total body surface area, with the majority being full-thickness burns (84.2%, n = 154). Almost half of the patients (49.2%, n = 90) had bilateral hand burns, leading to a total of 273 hands treated. The treatments included a 3-stage DRM for 66.7% (n = 182), a 2-stage DRM for 20.9% (n = 23), direct grafting for 8.4% (n = 23), and skin substitutes only for 4.1% (n = 11). The 3-stage DRM significantly reduced the odds of requiring repeat grafting during acute management (odds ratio = 0.03) and was associated with lower complication rates and need for delayed reconstruction. Objective hand function examination showed no significant difference in baseline or end of treatment DASH scores between 3-stage and 2-stage DRM groups.</p><p><strong>Conclusions: </strong>These data suggest a 3-stage approach reduced the need for repeat STSG. This approach may be especially useful when autologous skin is limited or if the patient requires multiple rounds of excision and grafting due to the nature and severity of the burn injury. Patients who received a 3-stage approach had comparable mean DASH scores when compared to patients who received a 2-stage approach, suggesting that a 3-stage approach does not diminish the functional benefits of DRM previously demonstrated in the literature.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S469-S473"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974867","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":"Clinicopathological Characteristics, Gene Mutations, and Treatment of Fibro-adipose Vascular Anomaly: A Case Series From China and Literature Review.","authors":"Fei Xiong, Cai-Jun Jin, Shi-Qi Wang, Hai-Yan Zhong, Miao Zheng, Ming-Li Zou, Qian Wang, Si-Ming Yuan","doi":"10.1097/SAP.0000000000004303","DOIUrl":"10.1097/SAP.0000000000004303","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study is to offer a thorough overview of the clinical and pathological characteristics, potential pathogenic genes, treatment modalities, and prognoses of a cohort of Chinese individuals diagnosed with Fibro-adipose Vascular Anomaly (FAVA). This study aims to advance the comprehension of this specific medical condition.</p><p><strong>Methods: </strong>A total of 15 cases of FAVA patients admitted to our center between June 2015 and December 2023 were included in this study. Clinical symptoms, laboratory tests, imaging findings, and pathological data were systematically reviewed to outline the clinical and pathological features of FAVA. Furthermore, whole-exome sequencing was conducted on lesion samples from five patients to identify potential pathogenic genes. The treatment modalities encompassed sclerotherapy and surgical interventions, with treatment outcomes assessed based on clinical symptoms, imaging characteristics, and enhancement of limb functions.</p><p><strong>Results: </strong>The FAVA lesions were predominantly located in the limbs in 14 patients and in the trunk in 1 patient. The clinical manifestations included pain (9/15, 60%), muscle contracture deformity (3/15, 20%), and joint dysfunction (3/15, 20%). Coagulation function assessments indicated that 3 patients exhibited localized intravascular coagulation (LIC). Magnetic resonance imaging (MRI) findings displayed mixed vascular malformation components and fibrofatty components within the muscles, showing isointense or hyperintense signals on T1-weighted images and heterogeneous hyperintense signals on T2-weighted images. Histopathological analysis revealed activation of the PI3K-AKT-mTOR signaling pathway. Whole-exome gene sequencing of 5 cases identified 10 genes potentially linked to pathogenicity. All patients underwent ethanol sclerotherapy. Surgical intervention was performed on five patients due to muscle contracture and joint dysfunction. Some patients reported pain relief following sclerotherapy, whereas those who underwent surgery demonstrated significant enhancement of joint function.</p><p><strong>Conclusions: </strong>The Chinese patients diagnosed with FAVA in this study presented characteristic clinical symptoms, imaging features, and pathological traits. The lesion tissue showed activation of the PI3K-AKT-mTOR signaling pathway, with only one patient (1/5, 20%) exhibiting a PIK3CA mutation. This finding underscores the intricate nature of the pathogenic genes and pathogenesis of FAVA. Although sclerotherapy demonstrated restricted efficacy in alleviating pain symptoms, surgical intervention was deemed necessary for addressing joint dysfunction resulting from muscle contracture.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"581-588"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Women's Representation of Plastic Surgery Residency and Fellowship Program Leadership From a National Lens.","authors":"Xinfei Miao, Madeleine Givant, Van Le, Katie Kyan, Ashley Choi, Reem Sarsour, Amber Leis","doi":"10.1097/SAP.0000000000004279","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004279","url":null,"abstract":"<p><strong>Background: </strong>Among all surgical specialties, plastic surgery has had the most significant growth in women trainees and leadership positions from 2008 to 2018. Despite this increase, studies have shown that from trainees to faculty to leadership roles, leakage occurs at all levels in the pipeline. We aim to investigate the gender distribution of leadership positions by plastic surgery program type and geographic region, as well as to compare the leadership representation across plastic surgery subspecialty fellowships.</p><p><strong>Methods: </strong>All integrated plastic surgery residency programs and four main subspecialty fellowship programs in the US were identified through the American Council of Academic Plastic Surgeons. Leadership roles, such as program director, assistant/associate program director (APD), fellowship program director, and departmental and divisional level leadership roles, which are occupied by women, were collected from program websites, along with the number of individuals holding additional leadership roles. Programs were classified as either university-based or nonuniversity-based types. Program location was cross-referenced with the US Census Bureau to determine their regions. Categorical variables were compared by χ2 or Fisher's exact tests, as appropriate, using Microsoft Excel 2021.</p><p><strong>Results: </strong>A total of 88 integrated plastic surgery residency programs were identified, along with 33 craniofacial surgery, 82 hand surgery, 61 microsurgery, and 47 aesthetic surgery fellowship programs. Overall, women represent 20.9% of program directors, 44.2% of APDs, 10.7% of fellowship program directors, and 18.1% of departmental and divisional level leadership roles. Fewer women are holding additional leadership roles (22.3% vs 77.7%). A significant difference was found in the APD position by program type. The aesthetic surgery fellowship has the lowest women's representation in leadership, while hand surgery has the highest (9.09% vs 17.1%). No significant difference in gender distribution was observed across fellowship types.</p><p><strong>Conclusions: </strong>While leadership gender distribution does not appear to be affected by region or program type, women plastic surgeons remain underrepresented at different leadership levels. Providing enhanced career advancement and support for diverse representation is vital to creating an inclusive plastic surgery leadership workforce.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S425-S428"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954436","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":"Pediatric Scar Management Using Tangential Excision With Intralesional Injections and Laser-Assisted 5-Fluorouracil Delivery.","authors":"Kelli Lopes, Samuel Lance, Cyril Harfouche, Robert Clark, Miriam Becker, RocNeil Nguyen, Amanda Gosman","doi":"10.1097/SAP.0000000000004207","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004207","url":null,"abstract":"<p><strong>Background: </strong>Pediatric hypertrophic and keloid scars have traditionally been treated via intralesional steroid injections. The advent of modalities such as 5-fluorouracil (5-FU) and tangential excision present opportunities for improved therapy; however, 5-fluorouracil (5-FU) safety and efficacy in the pediatric population are not well established. The aim of this study is to compare the risk and efficacy of 5-FU in pediatric scar management.</p><p><strong>Methods: </strong>A multi-institution retrospective study from 2012 to 2023 was designed with identification of 108 patients aged ≤17, undergoing CO2 laser-assisted 5-FU delivery, or tangential excision with immediate or delayed 5-FU/triamcinolone injections. Modified Scar Rating Scale assessed individual scar outcomes comparing the following groups: 5-FU alone versus triamcinolone use; tangential excision with immediate versus delayed injections; and number of injections above/below the median of 4 episodes of injections. Mann-Whitney U test determined significance. Fisher exact test compared complication and recurrence rates.</p><p><strong>Results: </strong>Total scar quality scores improved (P < 0.05) with tangential excision plus <4 injections (n = 44; Δ = -0.581) and tangential excision with 5-FU only (n = 39; Δ = -0.775). Tangential excision with 5-FU alone decreased height (P < 0.05; Δ = -0.5878) compared to tangential excision with triamcinolone use (n = 46). Color match improved (P < 0.05) with tangential excision plus <4 injections (Δ = -0.449) and tangential excision with delayed injections (n = 29; Δ = -0.380).Tangential excision with any 5-FU use (n = 62) had higher complication rates (4.84%) than tangential excision with triamcinolone only (n = 30; 0%) or tangential excision with 5-FU only (n = 37; 5.41%), but complication rates did not significantly differ. CO2 laser-assisted 5-FU (n = 16) complication rates (6.25%) did not significantly differ from tangential excision with 5-FU or triamcinolone. No systemic complications were identified. Recurrence rates between all groups did not differ significantly.</p><p><strong>Conclusions: </strong>Tangential excision with 5-FU monotherapy demonstrated lower scar height and improved overall scar quality, further solidifying the benefits of 5-FU. CO2 laser-assisted 5-FU delivery had similar complication rates as the other studied modalities. This pediatric study had no systemic complications and overall similar complication rates compared to adult studies. This study demonstrates the utility of 5-FU in pediatric scar therapy and provides data regarding novel approaches to difficult pediatric scar management.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S429-S434"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954919","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":"Degree and Timing of Sensory Return Following Nipple-Areolar Complex Neurotization During Nipple-Sparing Mastectomy.","authors":"Gabrielle Guido, Ziv M Peled, Anne Warren Peled","doi":"10.1097/SAP.0000000000004282","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004282","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional expectations around sensation following nipple-sparing mastectomy include significant or often complete sensory loss of the nipple-areolar complex. Nipple neurotization at the time of mastectomy has proven promising in restoring sensation to the area postoperatively. However, minimal data are available on the degree and timing of sensory return following neurotization.</p><p><strong>Methods: </strong>Forty-seven patients (representing 94 breasts) underwent nipple-sparing mastectomy (NSM) with direct-to-implant, prepectoral reconstruction. During the mastectomy, branches of the T4 and T5 lateral intercostal nerves were identified and dissected to preserve length before transection was required oncologically to complete the mastectomy. The nerves were then reconstructed using a nerve allograft or autograft with coaptation to an identified subareolar nerve. Neurosensory testing with a pressure-specified sensory device was performed at several time points postoperatively to quantify return of sensibility. Patients were also given modified BREAST-Q questionnaires at similar time points to assess their perception of sensation return.</p><p><strong>Results: </strong>Nipple sensation decreased markedly in the early months after mastectomy and then slowly returned to baseline by 1 year postoperatively, with 74% of patients achieving pressure-specified sensory device results in the excellent range by 12-month testing. Overall, patients having bilateral risk-reducing mastectomy achieved higher rates of nipple sensory return at 1 year than those having mastectomies as part of cancer treatment. On patient-reported outcomes, 53% of patients reported having a lot or some nipple sensation by 6 months postoperatively, which increased to 70% by 1 year. Ninety-two percent of patients reported responsiveness to touch in their nipples at the 12-month postoperative time point.</p><p><strong>Conclusions: </strong>Nipple-areolar complex neurotization allows for return to baseline nipple sensation on quantitative testing by 1 year postoperatively for the vast majority of patients undergoing the procedure. Similar results are seen for patient-reported outcomes on overall nipple sensation and responsiveness to touch. As adoption of sensation preserving mastectomy techniques becomes more widespread, further investigation into optimal assessment tools and protocols will continue to improve understanding of outcomes and help with patient expectation setting.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S452-S456"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960360","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}