Comparison of Aesthetic Outcomes of Epidermal Staples vs Sutures in Deep Epigastric Perforator Flap Breast Reconstruction.

Background: A secondary benefit of abdominally based autologous breast reconstruction may be improving the abdominal contour; however, poor scaring can lead to aesthetic dissatisfaction and complications. Although studies have demonstrated favorable aesthetic results and decreased operative time using dermal or subcuticular stapling (Insorb), no reports exist regarding epidermal stapling. Objectives: The aim of this study is to compare the aesthetic abdominal scar outcomes, closure time, and postoperative complications of abdominally based breast reconstruction patients who have undergone suture closure vs epidermal staple closure. Methods: A total of 217 patients who underwent abdominally based autologous breast reconstruction from 2011 to 2022 were included and retrospectively analyzed (staples = 41, suture = 176). Twenty-four patients' postoperative abdominal scar photographs were randomly chosen (staples = 12, sutures = 12) and assessed by 3 board-certified plastic surgeons using a modified patient observer scar assessment scale (POSAS) and visual analog scale (VAS). Closure time (minutes per centimeter) using staples or sutures was also analyzed. Results: The assessment of abdominal scars closed by epidermal staples revealed significant improvements in thickness (P = .033), relief (P = .033), surface area (P = .017), overall opinion (P = .033), POSAS score (P = .034), and VAS scar score (P = .023) in comparison with scars closed by sutures. Closing the abdominal wound with staples was significantly faster than closing with sutures (P < .0001). Staple and suture closure had similar postoperative complication rates. Conclusions: Abdominal donor-site scar quality may be superior and faster using the epidermal staple compared to traditional suture closure.

Overcoming Barriers to Board Certification.

This Viewpoint outlines 3 aspects of specialty board examinations that place undue burdens on candidates and proposes strategies to address these barriers.

Algorithm for Trim and Wedge Labiaplasties.

In the last decade labiaplasty procedures have been on the rise in the United States. The trim and the wedge are among the most commonly used techniques. The purpose of this paper is to provide a trim-wedge algorithm to guide the surgeon based on the qualities of the individual patient. The choice of technique should be based on the reasonable labiaplasty candidate's goals, her nicotine/cocaine usage, and the physical characteristics of her labia, including edge quality, texture, pigmentation, symmetry, morphology of protrusion, and labial length. By considering these individual patient factors, the trim-wedge algorithm may improve labiaplasty outcomes and increase patient satisfaction. Some surgeons perform only the wedge or only the trim, and no algorithm should alter that. After all, the best technique is always the one the surgeon performs comfortably and safely.

Cross-Sectional Analysis of Instagram Use in American Plastic Surgery Practices.

BACKGROUND: The growth of social media has transformed advertising within plastic surgery. Recent studies have characterized these developments, but objective analysis is needed. METHODS: This is a cross-sectional analysis of online media use by American Society of Plastic Surgeons members who received board certification in 2000, 2005, 2010, 2015, or 2019. Online searches and StatShow revealed social media and website metrics. Metropolitan-based practices were determined using Department of Agriculture continuum codes. Descriptive and quantitative analyses were used to make inferences regarding study aims. RESULTS: This study included 811 surgeons. A total of 58.6 percent had practice websites and 43.9 percent had professional Instagram accounts. Instagram use was widespread across subspecialties and there was no significant difference in the number of followers by subspecialty ( p = 0.34). Year of certification had no significant effect on the number of followers ( p = 0.12); however, recently certified and seasoned members had the fewest. The top 1 percent of surgeons had more followers than the remaining 99 percent combined. Those with metropolitan-based practices had significantly higher website traffic ( p = 0.01) but no difference in the number of followers ( p = 0.88). There was no evidence that the number of followers or posts per month correlated with website traffic ( R 2 = 0.004 and 0.036, respectively). CONCLUSIONS: The study demonstrates findings from a cross-sectional analysis of plastic surgeons from different training backgrounds, regions, and tenure. The use of Instagram in professional practice is widespread but there is no correlation between its use and increased website traffic.

The Positive Patient Experience: A Comprehensive Analysis of Plastic Surgery Online Reviews.

BACKGROUND: Subjective online physician evaluation is an important component of patient decision-making. Understanding reviews may improve satisfaction and build positive online reputation. OBJECTIVES: The aim of this study was to analyze and compare the top predictive factors driving patient satisfaction across the most popular plastic surgery procedures. METHODS: Online reviews were analyzed from RealSelf, Yelp, and Google for the 5 highest-rated plastic surgeons in 6 US metropolitan areas. Blank, non-English, consultation, duplicate, and unrelated reviews were excluded. Data from free-text reviews included physician rating, patient-reported reasons for rating, procedure, and complications. Univariate analysis was performed to compare predictive factors of online ratings. RESULTS: In total, 11,078 reviews were included. RealSelf had the highest average rating (4.77), and Yelp had the lowest (4.66). Reviews in Miami, Philadelphia, New York City, and Chicago were mostly published on RealSelf, whereas Houston and Los Angeles mostly used Google and Yelp, respectively. Reconstructive procedures were rated significantly higher than cosmetic procedures (P = 0.035). Aesthetic appearance was the strongest predictor of rating across all procedures. Buccal fat removal (98.8%) and abdominoplasty (98.1%) had the highest satisfaction, and Brazilian butt lift had the lowest (88.2%) (P < 0.001). Additional significant contributors included staff interaction, bedside manner, health outcomes, complications, and postoperative care (P < 0.001). CONCLUSIONS: Although aesthetic outcome is an important predictor of satisfaction, other aspects of care, such as bedside manner and staff interaction, provide an important foundation of support. Excellent patient-surgeon communication and postoperative care may mitigate patient dissatisfaction and elicit high-satisfaction online patient reviews.

Labiaplasty: Analysis of the National Surgical Quality Improvement Program Database.

BACKGROUND: Labiaplasty is an increasingly popular procedure performed for both cosmetic and pathologic etiologies. Questions have been raised regarding the efficacy of the procedure, especially for cosmetic etiologies. OBJECTIVES: The aim of this study was to examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies. METHODS: The 2005 to 2017 National Surgical Quality Improvement Program database was analyzed for patients who, according to the relevant Current Procedural Terminology code, had undergone labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases codes. Information was collected on patient demographic characteristics, patient comorbidities, and operative variables. Outcomes of interest included surgical complications and delayed length of stay (DLOS). A univariate analysis and multivariate logistic regression were applied to determine statistically significant predictors of our outcomes of interest for both etiologies. RESULTS: There were 640 patients in the cosmetic cohort and 1919 patients in the pathologic cohort. There were no significant differences in rates of surgical complications between the 2 groups, but there was a statistically significant increase in length of stay for the pathologic group. Univariate analysis revealed operative time and plastic surgeon specialty to be predictive of DLOS in the cosmetic cohort. No covariates were implicated with multivariate analysis for either surgical complications or for DLOS in the cosmetic cohort. CONCLUSIONS: Our findings suggest that cosmetic labiaplasty is a safe and efficacious procedure with low complication rates and no predictors of adverse outcomes.

The Safe Practice of Female Genital Plastic Surgery.

The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient's motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.

Patient Reviews: Yelp, Google, Healthgrades, Vitals, and RealSelf.

BACKGROUND: Online reviews play a significant role in influencing a patient's choice of a plastic surgeon. The purpose of this article is to help the practicing plastic surgeon understand reviews and review websites. METHODS: A review of both the medical literature and online blogs was performed to identify the most current information pertinent to plastic surgeons. RESULTS: Negative reviews can impact a potential patient's decision on where to seek plastic surgery, and the best way to dilute that impact is to attract good reviews. Good reviews result from running an excellent practice, and patient surveys can help identify and address problems. The qualities of each of the seven online patient review websites are summarized, along with practice advice on how to attract reviews and how to deal with fake, fraudulent, and negative reviews. CONCLUSIONS: Reviews impact plastic surgeons, whether or not they are aware of what patients are saying about them online. This article helps plastic surgeons become familiar with how to use reviews for practice growth and how to protect their online reputation.