Feasibility of leveraging menstrual cycle tracking apps for preconception research recruitment.

Background: Mobile applications (apps) present a new opportunity to study menstrual cycles and time to pregnancy. Understanding the characteristics of cycle tracking app users is important to evaluate the feasibility of recruiting participants for preconception research. Methods: Users of a cycle tracking smartphone app, Ovia Fertility, aged 18 or older in the U.S. were randomly invited via email to complete a "fertility research" questionnaire that included demographic and reproductive characteristics. Among those attempting pregnancy without medical assistance, attempt duration, factors influencing pregnancy planning, health history and behaviors while attempting to conceive were queried. Respondents could choose to enter a raffle for a $50 gift card. Results: Initially, 639 people responded to the demographics portion of the survey representing 49 states and Washington DC. Of these, 344 (54%) were trying to conceive and of those, 297 (86%) were not using medical treatments. Of those not trying to conceive, 12% reported that they planned to start in the next 3 months. Most participants were ages 26-35 (63%), of White race (70%), reported non-Hispanic ethnicity (87%), had at least a bachelor's degree (56%) and an income between $50,000 and $200,000 (58%). One-third were of recommended BMI (35%), 24% overweight, and 41% obese. Most participants reported no fertility-related health conditions (58%). Forty-eight participants (17%) had been trying to conceive for 1 month or less, 88 (31%) had been trying for 2 months or less, and 122 (43%) for 3 months or less. Interruptions in pregnancy attempts were common, 31% reported periods without intercourse. Of those attempting pregnancy, 47% of partners completed their own questionnaire. Conclusion: This first-of its-kind analysis describes users of a cycle-tracking smartphone app who could be eligible for recruitment to a prospective time-to-pregnancy study. Survey respondents were diverse with respect to geographic location, BMI, and income. However, special recruitment efforts will be needed to recruit participants and partners who identify as other than non-Hispanic White. Participants with fertility-related conditions are not overly represented among app users who are trying to conceive. Targeting and pre-enrolling app users who are planning to begin a pregnancy attempt in the next 3 months may be an advantage of app-based recruitment.

Risk Factors Associated with Severe Macromastia among Adolescents and Young Women.

BACKGROUND: Macromastia is common among adolescents and young women and has well-documented negative physical and psychosocial effects. The pathogenesis of idiopathic macromastia has been attributed to increased end organ sensitivity to circulating gonadal hormones. Despite the known negative effects of macromastia, there is a paucity of literature examining the clinical risk factors associated with macromastia severity in this age group. METHODS: In this cross-sectional study, standardized clinical forms were administered to patients between the ages of 12 and 21 years undergoing reduction mammaplasty. Data were collected pertaining to patient demographics, biometrics, breast symptoms, medical and family history, and breast tissue resection mass at the time of reduction. Resection mass was normalized to patient body surface area in analyses. RESULTS: A total of 375 patients were included in analyses. Mean age at surgery was 18.1 years. The following risk factors were positively associated with macromastia severity in both univariate and multivariate logistic regression models: overweight or obesity, racial or ethnic minority status, patient-reported gynecologic or endocrine complaints, and early menarche ( p < 0.05, all). More severe cases of macromastia were associated with approximately three times the odds of being overweight or obese or achieving menarche before 11 years old. CONCLUSIONS: In our sample, overweight or obesity, racial or ethnic minority status, early menarche, and patient-reported gynecologic or endocrine complaints were all positively associated with macromastia severity. Awareness of these factors can empower physicians to identify and address modifiable risk factors to prevent progression to more severe disease. Macromastia itself should prompt screening for gynecologic or endocrine complaints with referral as indicated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Normative Values for Adolescent Quality of Life in Plastic Surgery: A Longitudinal, Cohort Study.

Background: Adolescence is a challenging time, and an increasing number of young people are seeking plastic surgery. With the rise of health-related quality of life studies in plastic surgery, it is critical to understand the natural variation and changes in health-related quality of life for this population. Methods: In this longitudinal, cohort study validated surveys were administered to cisgender participants aged 12-21 years: Short-Form 36v2, Rosenberg Self-Esteem Scale, Breast-Related Symptoms Questionnaire, and Eating-Attitudes Test-26. Surveys were administered at baseline and up to 9 years follow-up. At the time of enrollment, participants were in a current state of good health with no considerable past or current medical, surgical, or psychological history. Results: A total of 149 female and 75 male participants were included, with a median (interquartile range) baseline age of 16.0 (4.4) years and follow-up time of 3.3 (4.1) years. Over the study period, girls who were not overweight or obese experienced significant declines in five SF-36 domains (general health, vitality, social functioning, role-emotional, and mental health) and on the Rosenberg Self-Esteem Scale, Breast-Related Symptoms Questionnaire, and Eating-Attitudes Test-26 (P < 0.05). In contrast, boys' and overweight/obese girls' health-related quality of life largely remained stable (P > 0.05). Conclusions: Adolescence is a challenging time, on which plastic surgery-related concerns are superimposed. Our findings suggest that girls may be more at risk for developing psychosocial deficits that worsen over adolescence and young adulthood. This observation is critical for the interpretation and contextualization of health-related quality of life in adolescent plastic surgery patients.

Complications and Quality of Life following Gynecomastia Correction in Adolescents and Young Men.

BACKGROUND: Persistent adolescent gynecomastia negatively affects health-related quality of life. Surgery results in psychosocial improvements, but the effects of postoperative complications on health-related quality of life are unknown. The authors examined whether complications following adolescent gynecomastia surgery impact postoperative health-related quality of life. METHODS: Patients aged 12 to 21 years who underwent surgical correction of unilateral/bilateral gynecomastia between 2007 and 2019 were enrolled (n = 145). Relevant demographic and clinical data were obtained from medical records. Fifty-one patients completed the following surveys preoperatively, and at 6 months and 1, 3, 5, 7, 9, and 11 years postoperatively: 36-Item Short-Form Health Survey (Version 2), Rosenberg Self-Esteem Scale, and the 26-item Eating Attitudes Test. RESULTS: Within a median period of 8.6 months, 36 percent of breasts experienced at least one complication. The most common were residual tissue (12.6 percent), contour irregularities (9.2 percent), and hematomas (7.8 percent). Patients reported significant postoperative improvements in self-esteem and in seven health-related quality-of-life domains (Physical Functioning, Role-Physical, Bodily Pain, Vitality, Social Functioning, Role-Emotional, and Mental Health) at a median of 33.3 months. Postoperative survey scores did not vary by grade or procedure, or largely by body mass index category or complication status. However, patients aged younger than 17 years at surgery scored significantly higher than older patients in the Short-Form Health Survey Vitality and Mental Health domains postoperatively. CONCLUSIONS: Health-related quality-of-life improvements are achievable in adolescents through surgical correction of persistent gynecomastia. Postoperatively, patients largely experienced similar health-related quality-of-life gains irrespective of complication status, grade, surgical technique, or body mass index category. Minor postcorrection complications are but do not appear to limit postoperative health-related quality-of-life benefits.

Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty.

Graduate medical education (GME) programs are vital to developing future plastic surgeons. However, their cost-efficiency has yet to be contextualized. This cohort quality improvement (QI) project aimed to measure the indirect costs an institution assumes in training surgical residents, by comparing the differences in operative time and procedural charges between a resident and a physician assistant (PA) first-assisting during adolescent reduction mammaplasty. METHODS: From 2013 to 2019, adolescent bilateral reduction mammaplasty procedures first-assisted by either a resident or physician assistant were considered for analysis. Financial data, including all hospital and physician expenditures and operation duration, patient demographics, and outcomes data were retrospectively collected. RESULTS: A total of 49 reduction mammaplasty cases were included for analysis. Residents had an average of 5.9 ± 1.5 years of post-graduate surgical training, whereas the PA had 2 years of surgical experience. Procedures first-assisted by a surgical resident took a mean/median of 34 minutes longer and were $3750 more expensive, respectively, than cases first-assisted by a PA (P < 0.01, both). CONCLUSIONS: Reduction mammaplasty procedures were longer and accrued higher charges when first-assisted by a surgical resident than by a PA. Although Graduate Medical Education programs are necessary to train the next generation of surgeons, they may result in unintended opportunity costs for teaching hospitals. Federal support to academic medical centers aims to cushion the cost of residential training, but is insufficient to compensate for resident inefficiency. Hospitals may consider incorporating PAs into the Graduate Medical Education paradigm to alleviate administrative burden, lower operational charges, and enhance resident training curricula.

Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults.

The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients with congenital deficiencies. This study reports early and late outcomes from a cohort of young, primarily syndromic patients undergoing microvascular mandibular reconstruction. METHODS: This is a retrospective case series of patients who underwent microvascular mandibular reconstruction between 1995 and 2016. RESULTS: Thirteen patients received a total of 13 fibula transfers and 1 medial femoral condyle transfer. Most patients carried a congenital diagnosis (77%), and the average age during surgery was 11.7 ± 5.7 years. The median (interquartile range) [IQR] length of follow-up was 6.3 (5.7) years. There was a 100% flap survival rate, although 86% of all patients experienced at least one complication. Half of all procedures resulted in an early complication. Nine patients (69%) developed late complications, of which temporal mandibular joint ankylosis was the most common (n = 5; 38%). CONCLUSIONS: This study is one of few detailing outcomes following mandibular reconstruction by free flap transfer in pediatric patients. These patients were primarily syndromic with appreciable complication rates higher than in other adult and pediatric studies. Some complications are manageable or self-resolving, but others lead to functional problems that may require late operative interventions to correct. Microsurgical treatment should be reserved for children with large, complex mandibular defects when other options are unavailable or have been exhausted.