Outcomes of Extended Pedicle Technique vs Free Nipple Graft Reduction Mammoplasty for Patients With Gigantomastia.

BACKGROUND: Optimal reduction mammoplasty techniques to treat patients with gigantomastia have been debated and can involve extended pedicles (EP) or free nipple grafts (FNG). OBJECTIVES: The authors compared clinical, patient-reported, and aesthetic outcomes associated with reduction mammoplasty employing EP vs FNG. METHODS: A multi-institutional, retrospective study of adult patients with gigantomastia who underwent reduction mammoplasty at 2 tertiary care centers from 2017 to 2020 was performed. Gigantomastia was defined as reduction weight >1500 g per breast or sternal notch-to-nipple distance ≥40 cm. Surgeons at 1 institution employed the EP technique, whereas those at the other utilized FNG. Baseline characteristics, preoperative and postoperative BREAST-Q, and clinical outcomes were collected. Aesthetic outcomes were assessed in 1:1 propensity score-matched cases across techniques. Preoperative and postoperative photographs were provided to reviewers across the academic plastic surgery continuum (students to faculty) and non-medical individuals to evaluate aesthetic outcomes. RESULTS: Fifty-two patients met the inclusion criteria (21 FNG, 31 EP). FNG patients had a higher incidence of postoperative cellulitis (23% vs 0%, P < 0.05) but no other differences in surgical or medical complications. Baseline BREAST-Q scores did not differ between groups. Postoperative BREAST-Q scores revealed greater satisfaction with the EP technique (P < 0.01). The aesthetic assessment of outcomes in 14 matched pairs of patients found significantly better aesthetic outcomes in all domains with the EP procedure (P < 0.05), independent of institution or surgical experience. CONCLUSIONS: This multi-institutional study suggests that, compared with FNG, the EP technique for reduction mammoplasty provides superior clinical, patient-reported, and aesthetic outcomes for patients with gigantomastia.

Evaluation of Artificial Intelligence-generated Responses to Common Plastic Surgery Questions.

Background: Artificial intelligence (AI) is increasingly used to answer questions, yet the accuracy and validity of current tools are uncertain. In contrast to internet queries, AI generates summary responses as definitive. The internet is rife with inaccuracies, and plastic surgery management guidelines evolve, making verifiable information important. Methods: We posed 10 questions about breast implant-associated illness, anaplastic large lymphoma, and squamous carcinoma to Bing, using the "more balanced" option, and to ChatGPT. Answers were reviewed by two plastic surgeons for accuracy and fidelity to information on the Food and Drug Administration (FDA) and American Society of Plastic Surgeons (ASPS) websites. We also presented 10 multiple-choice questions from the 2022 plastic surgery in-service examination to Bing, using the "more precise" option, and ChatGPT. Questions were repeated three times over consecutive weeks, and answers were evaluated for accuracy and stability. Results: Compared with answers from the FDA and ASPS, Bing and ChatGPT were accurate. Bing answered 10 of the 30 multiple-choice questions correctly, nine incorrectly, and did not answer 11. ChatGPT correctly answered 16 and incorrectly answered 14. In both parts, responses from Bing were shorter, less detailed, and referred to verified and unverified sources; ChatGPT did not provide citations. Conclusions: These AI tools provided accurate information from the FDA and ASPS websites, but neither consistently answered questions requiring nuanced decision-making correctly. Advances in applications to plastic surgery will require algorithms that selectively identify, evaluate, and exclude information to enhance the accuracy, precision, validity, reliability, and utility of AI-generated responses.

Re-evaluating the Lejour Technique for Breast Reduction in Patients with Macromastia.

BACKGROUND: Limited scar Lejour technique for breast reduction is conventionally used to remove less than 500 g of breast tissue per breast, but is effective for greater macromastia. Plastic surgery residents gain limited experience with this technique, and it is infrequently performed in the United States. To understand technique selection, we surveyed board-certified plastic surgeons and compared outcomes with the Lejour technique in 1 practice to those with other methods. METHODS: We surveyed American Society of Plastic Surgeons members about techniques for breast reduction and compared outcomes with procedures performed by various techniques by a single surgeon (M.C.). RESULTS: Of 321 survey respondents, 33% reported formal training in the Lejour technique. Over 70% used mainly the inferior pedicle Wise procedure; 14% used mainly the Lejour or modified Lejour technique. In a series of reduction mammaplasties by 1 surgeon in 119 patients between 1997 and 2006, 14 underwent inferior pedicle Wise pattern and 105 involved the Lejour technique. Mean tissue mass removal was 1,136 g/breast (range, 170-4,050 g). Major complications occurred in 1.74% overall, and 0% and 1.9% for the Wise and Lejour techniques, respectively (P = 0.46). CONCLUSIONS: Although most American Society of Plastic Surgeons respondents were not formally trained in the Lejour technique and seldom perform the procedure, it can be employed for reduction mammaplasty with no greater risk of complications than the Wise method. The Lejour technique should be incorporated during residency training as an alternative for reduction mammaplasty.

Combined liposuction and excision of lipomas: long-term evaluation of a large sample of patients.

Background. Lipomas are benign tumors of mature fat cells. They can be removed by liposuction, yet this technique is seldom employed because of concerns that removal may be incomplete and recurrence may be more frequent than after conventional excision. Objectives. We assessed the short- and long-term clinical outcomes and recurrence of combined liposuction and limited surgical excision of subcutaneous lipomas. Methods. From 2003 to 2012, 25 patients with 48 lipomas were treated with liposuction followed by direct excision through the same incision to remove residual lipomatous tissue. Initial postoperative follow-up ranged from 1 week to 3 months, and long-term outcomes, complications, and recurrence were surveyed 1 to 10 years postoperatively. Results. Lipomas on the head, neck, trunk, and extremities ranged from 1 to 15 cm in diameter. Early postoperative hematoma and seromas were managed by aspiration. Among 23 survey respondents (92%), patients were uniformly pleased with the cosmetic results; none reported recurrent lipoma. Conclusions. The combination of liposuction and excision is a safe alternative for lipoma removal; malignancy and recurrence are uncommon. Liposuction performed through a small incision provides satisfactory aesthetic results in most cases. Once reduced in size, residual lipomatous and capsular tissue can be removed without expanding the incision. These favorable outcomes support wider application of this technique in appropriate cases.

Suboptimal ability of dirty-bedding sentinels to detect Spironucleus muris in a colony of mice with genetic manipulations of the adaptive immune system.

Spironucleus muris is an unacceptable infectious agent for most rodent colonies. Exposure of sentinel mice to dirty bedding and examination of sentinel intestinal smears was not sufficient for identification of the extent of spironucleosis within 1 mouse room. Clinical abnormalities were not reported in the animals housed in the room despite extensive breeding and a preponderance of mice genetically engineered to have nonfunctional T and B cells. In addition, researchers reported that the infection had not altered their research data. During investigation of the outbreak, direct intestinal smears performed on related animals (conspecifics, offspring, or siblings) revealed that immunodeficient mice often tested negative whereas the immunocompetent cohort tested positive. In this study, we used culled colony animals and compared direct intestinal exam test results with histologic results. The comparison showed the extent of false negatives that may occur when direct intestinal exam alone is used to detect this protozoon. Sensitivity of the direct intestinal exam for detection of S. muris was calculated to be 71%, while histology sensitivity was 91%. In light of the study results and an extensive literature review, we revised our health surveillance plan so that the age and duration of exposure to dirty bedding among sentinel mice is varied at the time of testing.

Detection of Spironucleus muris in unpreserved mouse tissue and fecal samples by using a PCR assay.

The purpose of this study was to develop a rapid DNA isolation method and a sensitive and specific PCR assay for detecting Spironucleus muris in mouse tissue and fecal samples. A PCR assay based on the carboxy terminus of the elongation factor 1a gene was developed; the PCR product was confirmed by nucleic acid sequencing and nested PCR. The new PCR assay then was used to test feces from animals that had been screened for S. muris by using direct intestinal examination and histology. The PCR assay was determined to be a more sensitive test than either direct intestinal examination or intestinal histology. To our knowledge, this assay represents the first use of a PCR-based diagnostic screening method to confirm the presence of S. muris in murine tissue and fecal samples.

Naturally occurring murine norovirus infection in a large research institution.

Murine norovirus (MNV) is a recently discovered infectious agent in mice and may be the most common naturally occurring infection of laboratory mice in North America. In 2005, we surveyed the Swiss Webster female sentinel mice in our institute's research facilities. Of the 4 facilities surveyed, 3 had sentinel mice that were positive for MNV antibodies, whereas our largest facility (which only receives mice directly from select vendors or by embryo rederivation directly into the facility) was apparently MNV-free. However, testing of sentinel mice in this large facility 1 y later found that 2% of the animals had developed MNV-specific antibodies. In a recently opened fifth facility, a serologic survey in 2006 identified MNV-antibody-positive Tac:SW sentinel mice that had received bedding from experimental mice on the same rack quadrant. Reverse transcription- polymerase chain reaction analysis of feces from the cages of these mice showed evidence for shedding of MNV. These sentinel mice were used to study the fecal excretion, antibody development, gross lesions upon necropsy, histopathology, and immunohistochemistry of the viral infection. None of the MNV-antibody-positive sentinel mice exhibited clinical signs or gross lesions, but these mice excreted virus in feces and developed antibodies to MNV. Histopathologic lesions consisted only of a few hepatic inflammatory foci in each liver section, some of which were immunoreactive with antibodies to MNV. MNV viral antigens also were present in the mesenteric lymph nodes.