Plastic Surgery Commons^™

De-Epithelialization Versus Pedicle De-Skinning In Reduction Mammoplasty: Comparative Outcomes From The Literature, Samantha Fry, Karina Vizzoni

Rowan-Virtua Research Day

Background- Reduction mammoplasty treats symptomatic macromastia. A key step involves pedicle preparation before breast mound reconstruction. Two main techniques include: De-epithelialization: Removes epidermis, preserves dermis, De-skinning: Excises both epidermal and dermal layers. Evidence comparing surgical outcomes between these techniques is limited.

Hypothesis- De-epithelialization will result in fewer vascular complications but longer operative times than de-skinning; thus, superiority depends on case selection.

Methods- A literature review identified studies on skin removal techniques in breast reduction mammoplasty.

Results- De-skinning was faster than de-epithelialization, though energy-assisted modalities were fastest. Nipple–areola complex (NAC) ischemia and necrosis rates were low across all methods. Superficial de-epithelialization …

Factors For Successful Craniosynostosis Surgery Gofundme Campaigns, Annarose Taylor, Rena Atayeva, Shikha Trivedi, Phavon Sage, David Park, Brendan Podszus, Jessica Bigner, Yifan Guo

Knowledge and Creativity Expo

Introduction

Craniosynostosis surgery costs can be as high as 100,000 dollars. Even with complete insurance coverage, patients often face large out-of-pocket expenses. Thus, patients seek other financial resources. As a crowdfunding platform, GoFundMe (GFM) is one of those resources. The objective of our study was to identify GFM campaign factors associated with greater fundraising success.

Methods

GoFundMe.com was queried for: craniosynostosis, synostosis, brachycephaly, trigonocephaly, scaphocephaly, and fused skull suture. Included campaigns had patients in the U.S. fundraising for craniosynostosis surgery or related expenses. Excluded campaigns were duplicates, for animals, helmets, charities, or other surgeries. Successful campaigns achieved third quartile of …

Comparing Educational Pathways For Denturists To Become Maxillofacial Prosthetic Specialists In The Us And The Uk, Minseok Kim

Oral Health

Abstract

In the absence of formal training, licensure, and professionalism, this scientific literature review will seek to include denturists in the American maxillofacial prosthetics industry. Denturists are oral health professionals who perform oral examination, design, manufacture, and place removable oral prostheses. In other regions of the world, they are also known as clinical dental technologists and dental prosthetists. This practice is not widespread in the US. The review can also be assessed on the model mediated by PRISMA, which is concentrated on the experiences of international education in the United Kingdom, Canada, and Australia, where the concentration further revolves around …

Mapping Fat Embolism As A Complication Of Liposuction And Fat Grafting: A Systematic Review Of Anatomical And Technical Risk Factors, Jared Garfinkle, Jack Hennen, Wen Luo

Rowan-Virtua Research Day

Fat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). …

A Narrative Review Of Barriers To Utilization Of Surgical Risk Assessment Calculators, Jacob Lahti, Kaiya A. Noe, Abigail Veenstra, Sarah Gallitto, Victoria I. De Leon, Thomas C. Varkey, Nimit Agarwal

Annual Research Symposium

Over the last several decades, it has become the desire of surgical and medical teams to decrease risk levels involved for patients undergoing surgery. However, despite the advent of risk assessment calculators to help physicians obtain more accurate and objective judgements for postoperative complications, these tools are underutilized in standard clinical practices in comparison to other methods of risk assessment. This is likely due at least in part to certain barriers that decrease their functionality and ease of use. This review discusses the major barriers to the utilization of current risk calculators so as to allow for a better understanding …

Understanding The Impacts Of Surgical Drains On Postoperative Pain And Quality Of Life, Goutam K. Gadiraju, Matthew R. Prospero, Finn Tobias, Andrew J. Malek, Erik Reiche, Justin M. Broyles

School of Medicine Faculty Publications

Background: Surgical drains are commonly used in breast surgery and breast reconstruction for seroma prevention. Although many surgeons are aware that surgical drains can cause considerable discomfort to patients, less is understood about the specific impacts of drains on postoperative pain and quality of life (QOL). Methods: A cross-sectional survey was conducted among patients at our institution who had previously undergone mastectomy or breast reconstruction procedures to better understand patients' experiences with surgical drains. Patients were asked to report their attitudes toward a series of QOL statements and rate postoperative pain using numeric pain scales. Pair-wise analysis was used to …

A Unique Advantage Of A 24-Hour Surgical Delay In Autologous Breast Reconstruction, Devin M. Melancon, Daniel Yoo, Zachary Stern-Buchbinder, Samantha Morin, Hugo St. Hilaire, Robert J. Allen

School of Medicine Faculty Publications

Summary: The surgical delay technique can be used effectively in autologous breast reconstruction when there is unfavorable flap vascular anatomy or when the reconstruction necessitates a larger volume of donor tissue to obtain optimal results. The length of time between surgically delaying the flap to pedicle division and inset of the flap often varies based on surgeon preference but is typically approximately a week or longer. The authors present a case in which a 24-hour surgical delay was successfully used to augment deep inferior epigastric perforator flaps for autologous reconstruction. This technique is beneficial as it does not allow time …

Microvascular Autologous Breast Reconstruction With The Lateral Thigh Perforator Flap, Stefania M.H. Tuinder, Joep A.F. Van Rooij, Robert J. Allen

School of Medicine Faculty Publications

The lateral thigh perforator flap is an excellent alternative to the deep inferior epigastric artery perforator (DIEP) flap for patients with absolute or relative contraindications for a DIEP flap and adequate volume at the lateral thigh. Preoperative physical examination, preoperative markings, and radiological perforator mapping are essential for adequate surgical preparation. The flap is based on septocutaneous perforators of the lateral circumflex femoral artery, located in the posterior septum between the tensor fascia latae and the gluteus medius muscle. Being relatively stiff, septocutaneous perforators are sensitive to kinking and compression, which is important to keep in mind during flap inset. …

Hybrid Inferior Pedicle Reduction Mammaplasty With Free Nipple Grafts In A Patient With Gigantomastia, Devin M. Melancon, Harel G. Schwartzberg, Genevieve E. Messa, Jonathan C. Boraski

School of Medicine Faculty Publications

Gigantomastia presents a unique set of challenges for preservation of the nipple-areola complex in patients undergoing reduction mammaplasty. Historically an indication for breast amputation and free nipple graft (FNG), gigantomastia is now commonly treated using pedicle-based reconstruction. We present a case combining these two surgical techniques, using an inferior-pedicle reduction with an FNG in the management of extreme breast hypertrophy with 11,300g in total resected. This case report shows that such a technique for gigantomastia reductions can combine the aesthetic benefits of a pedicled reduction with the reliability of FNGs. These benefits make the hybrid inferior pedicle reduction a useful …

Decoding Implant-Related Sickness: Unraveling The Complexities Of Breast Implant Illness, Madison M. Stewart

Senior Theses

This thesis investigates the phenomenon of breast implant illness (BII), examining its potential correlation with individual factors such as obesity and poor lifestyle habits. BII, characterized by nonspecific symptoms, is often self-diagnosed by patients influenced by social media and internet sources, leading to requests for implant removal. Conducting a comprehensive meta-analysis, the study scrutinizes existing literature to evaluate the association between BII, obesity, and lifestyle choices. Employing inclusion criteria, peer-reviewed publications are analyzed through systematic review methodology to offer insights into the interplay between BII and adiposity, exploring inflammatory mechanisms and patient behaviors like exercise and smoking. The research aims …

Response To The Letter To The Editor: Surgical Delay Of Thoracodorsal Artery Perforator Flaps For Bilateral Autologous Breast Reconstruction, Robert J. Allen, Mark A. Maier

School of Medicine Faculty Publications

No abstract provided.

Surgical Delay Of Thoracodorsal Artery Perforator Flaps For Bilateral Autologous Breast Reconstruction, Ryan D. Hoffman, Mark A. Maier, Hugo St. Hilaire, Robert J. Allen

School of Medicine Faculty Publications

Summary; Autologous reconstruction accounts for nearly one-quarter of all breast reconstruction cases in the United States, with the abdomen functioning as the most popular donor site. This case describes a 62-year-old woman who presented to our clinic with a remote history of estrogen receptor+/progesterone+ breast cancer and bilateral implant-based reconstruction. After grade IV capsular contracture of her left breast, she presented for autologous reconstruction. Due to her body habitus and prior belt lipectomy, deep inferior epigastric perforator flap reconstruction was contra-indicated. The thoracodorsal artery perforator (TDAP) flap is well described in the literature, and was chosen as an alternative salvage …

Current Perspectives Of Oncoplastic Breast Surgery In Pakistan, Lubna Mushtaque Vohra, Dua Jabeen, Danish Ali, Syeda Sakina Abidi, Sana Zeeshan, Abida Khalil Sattar

Section of General Surgery

Oncoplastic breast surgery is based on the concept of tumour-specific immediate reconstruction. It combines both local and distant techniques to maintain breast texture, symmetry and cosmesis without compromising oncological outcome. The current narrative review was planned to highlight the current state and future of oncoplastic breast surgery in low- and middle-income countries where its utilisation in surgical practice remains insubstantial because majority of the surgeons who are treating breast cancer are either general surgeons or breast surgeons who do not have expertise in oncoplastic breast surgery or reconstructive surgery. Moreover, scarcity of financial resources, ignorance about oncoplastic breast surgery techniques, …

Panniculectomy Performed In Conjunction With Gynecologic Surgery In The Morbidly Obese Patient - A Nsqip Analysis And Meta-Analysis Of The Literature, Shayoni Nag, Tirth Patel, Steven C. Bonawitz

Rowan-Virtua Research Day

Purpose: Panniculectomy is a common procedure in plastic surgery, often performed following massive weight loss and in morbidly obese patients. It can be performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates.^{1, 2, 3} These studies fail to provide proof of these claims for reasons including study design and the lack of inclusion of both morbidly obese and non-morbidly obese patients. Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving towards penalizing practices which increase complications.

Methods/Results:We reviewed the NSQIP database to assess …

3 Cm Researchers Honored With Endowed Chairs, Children's Mercy Hospital

Our Story Continues

Susan Abdel-Rahman, PharmD received the Marion Merrell Dow/Missouri Chair in Pediatric Clinical Pharmacology. Shao Jiang, MD received the Frederick J. McCoy Endowed Chair in Plastic Surgery and Craniofacial Research. Cy Nadler, PhD received the Josh Barnds and Stella Carlson Endowed Professorship for Autism.

Tumor Biology And Racial Disparities In Reconstruction After Mastectomy: A Seer Database Analysis, Sarah J. Ullrich, Michael C. Smith, Paul J. Chung, Sara Y. Kim, Gainosuke Sugiyama

Journal of Health Disparities Research and Practice

Introduction:

Significant disparities in immediate breast reconstruction after mastectomy have persisted, and may even be increasing, despite large-scale efforts to minimize them, such as the Women’s Health and Cancer Rights Act of 1998. Immediate breast reconstruction has been shown to lead to higher rates of surgical satisfaction, minimize delay in post-operative cancer treatment, and improve the quality of life and overall well-being of mastectomy patients. However only 25-40% of eligible women in the United States receive reconstruction. The rate of reconstruction is even lower in African American and Hispanic women compared to White women. To better understand this disparity, …

A Breast Prosthesis Infection Update: Two-Year Incidence, Risk Factors And Management At Single Institution, Ashley Nadia Boustany, Shady Elmaraghi, Nneamaka Agochukwu, Benjamin Cloyd, Adam J. Dugan, Brian Rinker

Surgery Faculty Publications

Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients.

Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes.

Results: A total of 292 patients met the inclusion criteria. Fifty-five …