Menopause in Plastic Surgery Patients: an Underrecognized and Undertreated Comorbidity.

SUMMARY: Nearly half of all plastic surgery patients are middle-aged cis-gender women, all of whom will experience menopause. While plastic surgeons do not treat menopause directly, it can be a concern-and even a motivating factor-for patients seeking plastic surgery. Additionally, the changes associated with menopause underlie problems that many plastic surgeons seek to address, including in facelifts, breast surgery, and vaginal rejuvenation. Hormone therapy has the potential to improve quality of life for women by treating bothersome symptoms and delaying the physical changes brought on by loss of estrogen. However, recent reports in the media highlight that women face significant barriers to accessing menopause care due to a lack of trained providers willing to manage hormone therapy, as well as historical fears regarding increased cancer risk, which recent evidence suggests were overestimated. Plastic surgeons may be the first, or only, providers with whom women discuss how their bodies change with age. As a result, plastic surgeons should consider menopause as an underlying risk factor or comorbidity for any woman presenting with ageing-related complaints, and to ensure that these patients have access to appropriate menopause care in their communities. This is especially important for surgeons offering vaginal rejuvenation therapies, given that locally-acting topical estrogen is a safe and highly-effective treatment. Here we present guidance and recommendations for how plastic surgeons should take menopause into account when evaluating and advising patients. Additionally, we present a treatment algorithm for safe prescribing of locally-acting hormone therapy for vaginal rejuvenation.

Intracranial Pressure Patterns in Children with Sagittal Craniosynostosis.

BACKGROUND: Elevated intracranial pressure (ICP) in sagittal craniosynostosis has a wide spectrum of reported incidence, and patterns are not well understood across infancy and childhood. Characterizing the natural history of ICP in this population may clarify risks for neurocognitive delay and inform treatment decisions. METHODS: Infants and children with sagittal craniosynostosis and unaffected control subjects were prospectively evaluated with spectral-domain optical coherence tomography (OCT) from 2014-2021. Elevated ICP was determined based on previously validated algorithms utilizing retinal OCT parameters. RESULTS: Seventy-two patients with isolated sagittal craniosynostosis, and 25 control subjects were evaluated. Overall, 31.9% (n=23) of patients with sagittal craniosynostosis had evidence of ICP ≥15 mmHg, and 27.8% (n=20) of patients had ICP ≥20 mmHg.Children with sagittal craniosynostosis younger than 6 months of age were more likely to have normal intracranial pressure (88.6% <15 mmHg, 91.4% <20 mmHg) than those between 6-12 months of age (54.5%, p=.013; 54.5%, p=.005) and than those older than 12 months of age (46.2%, p<.001; 53.8%, p=.001). Intracranial pressure was directly correlated with severity of scaphocephaly (p=.009). No unaffected control subjects at any age exhibited retinal thickening suggestive of elevated ICP. CONCLUSIONS: Elevated ICP is rare in isolated sagittal craniosynostosis below 6 months of age, but becomes significantly more common after 6 months of age, and may correlate with severity of scaphocephaly.

Bilateral Digital Extensor Hypoplasia Correction: A Case Report and Systematic Review.

Digital extensor hypoplasia (DEH) is a rare malformation that presents with loss of active finger extension at the metacarpophalangeal (MCP) joints. Descriptions of optimal treatment and outcomes in this population are sparse. We describe successful operative treatment of a child with DEH involving the extensor digitorum communis, extensor digiti minimi, and the extensor indicis proprius tendons. The 5-year-old male patient was referred for severe limitation on bilateral finger extension since birth. He had been previously diagnosed with arthrogryposis and managed conservatively. Due to lack of improvement, magnetic resonance imaging was done evidencing hypoplasia/aplasia of the extensor tendons. The patient underwent successful tendon transfers using extensor carpi radialis longus to the common extensor tendons, and one hand required an additional tenolysis procedure. 2 years postoperatively, his MCP position and finger extension are markedly improved, and he is able to grip objects without limitation or difficulty. The patient returned to full activity without restriction.

Socioeconomic Disparities in Cleft Lip Care.

OBJECTIVE: The purpose of this study was to utilize a multicenter dataset to elucidate whether socioeconomic factors were associated with access to cleft lip surgery, treatment by higher-volume providers, and family choice for higher-volume centers. DESIGN: Retrospective cohort study. SETTING: Hospitals participating in the Pediatric Health Information System. PATIENTS: Primary cleft lip repair performed in the United States between 2010 and 2020. OUTCOMES: Travel distance, hospital volume, hospital choice. RESULTS: During the study interval, 8954 patients underwent unilateral (78.4%, n = 7021) or bilateral (21.6%, n = 1933) primary cleft lip repair. Patients with unilateral cleft lip were repaired significantly earlier if they were White (P < .001) and significantly later if they lived in an urban community (P = .043). Similarly, patients with bilateral cleft lip were repaired significantly earlier if they were White (P < .001). Patients from above-median income households (P = .011) and living in urban communities (P < .001) were significantly more likely to be treated at high-volume hospitals, whereas those living in underserved communities (P < .001) were significantly less likely to be treated at high-volume hospitals. White patients were significantly more likely to be treated by high-volume surgeons (P < .001). Patients with White race were significantly more likely to choose a higher-volume hospital than the one most locally available (P < .001). CONCLUSIONS: Patients with White race are more likely to travel farther and be treated by high-volume surgeons although at smaller hospitals. Patients from underserved areas travel significantly farther for cleft care and are treated at lower-volume hospitals. Patients in urban communities have shorter travel distances and are treated at higher-volume hospitals.

Understanding public perception of bra size.

BACKGROUND: Breast cup size is often used in conversations between patients and their surgeons to communicate about goals and expectations for postoperative results. Cup size, however, is a poorly defined concept. The goal of this study was to assess whether the perception of breast cup size is consistent in a general population of survey respondents. METHODS: A survey consisting of a demographic questionnaire, personal bra use questionnaire, and 27 de-identified preoperative images of patient's breasts was administered to 500 respondents using the Amazon MTurk platform. Survey respondents were asked to guess the cup size for each of 27 patients. RESULTS: On average, respondents correctly identified the patient's reported cup size 43.32% of the time. Male and female respondents chose the same cup size for most breast images. Survey respondents who had professional fittings were significantly less likely to accurately identify cup size (38.75% vs. 42.67%, p = 0.02). Those who had a personal history of breast surgery were also less likely to choose correctly (36.92% vs. 43.86%, p < 0.01). CONCLUSION: The results of this study suggest that the perception of cup size is broadly similar across a general population sample. However, subgroups who would be expected to have more knowledge about and experience with breast sizing-including women who have had professional bra fittings and women who have had breast surgery-differ significantly in their perception of cup size. This suggests that cup size language should be used with caution in preoperative discussions between patients and their surgeons.