Primary care doctor's perception about the scope of plastic surgeons: A national survey.

BACKGROUND: Plastic surgery is characterized by a broad spectrum of aesthetic and reconstructive surgical expertise that is not defined by an anatomic area. The authors sought to identify primary care doctors' perceptions of different fields of plastic surgery. METHODS: A short, anonymous, web-based survey was administered to primary care doctors in Portugal. Respondents were asked to choose the specialist they perceived to be an expert for 29 specific clinical areas, including 20 that are the core of plastic surgery practice. Specialists for selection included the following choices: dermatologist, general surgeon, maxillofacial surgeon, vascular surgeon, neurosurgeon, orthopedic surgeon, otolaryngologist, and plastic surgeon. RESULTS: A total of 430 complete answers to the survey were collected. Out of the 20 clinical cases related to plastic surgery, only nine were attributed to plastic surgery in the majority of the answers: thumb reimplantation (64,2%), abdominoplasty (93%), breast reduction (94%), otoplasty (62,3%), skin graft for a burn (97,7%), breast reconstruction (94,9%), complex open wound (57,2%), facial reanimation (36,7%) and first web space contracture of the hand (78,6%). CONCLUSIONS: There is a clear underestimation of the role of plastic surgery in a wide range of conditions, which may lead to the downsizing of plastic surgery departments in the national health system. It is of utmost importance to educate primary care doctors so that patients are referred correctly and in a timely manner.

Suspensory Ligament of the Mammary Gland: A Case Report.

BACKGROUND: The ligamentous system of the breast comprises a deep component, connecting the breast to the chest wall, and a superficial component, attached to the dermis and defining the breast contour. METHODS: A female patient with a family history of breast and ovarian cancer and presenting a bilateral fibrocystic mastopathy was submitted to surgical treatment with bilateral subcutaneous mastectomy and immediate reconstruction with implants. RESULTS: Intra-operatively, a strong ligament between the clavicle and the upper pole of the breast was identified. In addition, there was bilateral absence of the suspensory ligament of the axilla. CONCLUSIONS: Variations on the anatomy of the ligamentous system of the breast can represent alterations during the embryonic development of the breast and may have an important impact in the development of breast ptosis. LEVEL OF EVIDENCE V: This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.