Optimize Your First Impression: A Comparison of the Aesthetic Websites of Private Practices and Academic Institutions.

BACKGROUND: An aesthetic surgery offering within academic programs has positive financial and educational implications. To compete with private practices, academic institutions must view their website as integral to patient recruitment. OBJECTIVE: This study examines the aesthetic surgery websites of academic and private practices to compare objective website characteristics. METHODS: Integrated plastic surgery programs with an aesthetic surgery website were matched with nearby private practices offering cosmetic surgery. Data was collected from websites, including information about procedures, media, surgeon characteristics, design, reputation, finances, and readability, and compared using Chi-square and T tests. RESULTS: The websites of 68 academic institutions (AP) and 68 location-matched private practices (PP) were examined. Fourteen (17.07%) programs did not have a website. Private practice websites provided information about a greater number of procedures (mean AP 21.82, PP 27.04, p = 0.013), preparation for surgery (AP 52.94%, PP 83.82%, p < 0.001), and expectations after surgery (AP 70.59%, PP 88.24%, p = 0.01). Board certification was listed more frequently for private practices (AP 87%, PP 98%, p = 0.01). Academic websites were more likely to discuss research (AP 76%, PP 57.35%, p = 0.02). There was no significant difference in the readability of AP and PP websites (mean SMOG AP 7.70, PP 7.19, p = 0.06). CONCLUSIONS: This work demonstrates a significant content gap between private and academic aesthetic websites and serves as an action item for institutions to enhance their online presence. In a field traditionally associated with high overhead costs, website modifications represent a cost-effective way for academic practices to increase their appeal in the cosmetic surgery market. LEVEL OF EVIDENCE V: This journal requires that 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 .

Body wall development in lamprey and a new perspective on the origin of vertebrate paired fins.

Classical hypotheses regarding the evolutionary origin of paired appendages propose transformation of precursor structures (gill arches and lateral fin folds) into paired fins. During development, gnathostome paired appendages form as outgrowths of body wall somatopleure, a tissue composed of somatic lateral plate mesoderm (LPM) and overlying ectoderm. In amniotes, LPM contributes connective tissue to abaxial musculature and forms ventrolateral dermis of the interlimb body wall. The phylogenetic distribution of this character is uncertain because lineage analyses of LPM have not been generated in anamniotes. We focus on the evolutionary history of the somatopleure to gain insight into the tissue context in which paired fins first appeared. Lampreys diverged from other vertebrates before the acquisition of paired fins and provide a model for investigating the preappendicular condition. We present vital dye fate maps that suggest the somatopleure is eliminated in lamprey as the LPM is separated from the ectoderm and sequestered to the coelomic linings during myotome extension. We also examine the distribution of postcranial mesoderm in catshark and axolotl. In contrast to lamprey, our findings support an LPM contribution to the trunk body wall of these taxa, which is similar to published data for amniotes. Collectively, these data lead us to hypothesize that a persistent somatopleure in the lateral body wall is a gnathostome synapomorphy, and the redistribution of LPM was a key step in generating the novel developmental module that ultimately produced paired fins. These embryological criteria can refocus arguments on paired fin origins and generate hypotheses testable by comparative studies on the source, sequence, and extent of genetic redeployment.

"Quantifying the Impact of Prepectoral Implant Conversion on Patient Satisfaction and Quality of Life".

BACKGROUND: Conversion of subpectoral reconstruction to the prepectoral plane has been increasing in popularity. However, there is a paucity of research assessing patient-reported outcomes following this operation. The primary aim of this study is to examine patient-reported outcomes following conversion of implants from the subpectoral to prepectoral plane through utilization of the BREAST-Q. METHODS: We retrospectively examined patients who underwent subpectoral to prepectoral implant conversion by three surgeons at two separate centers from 2017-2021. Patient demographics, primary indication for the conversion, surgical characteristics, postoperative outcomes, and BREAST-Qs were obtained. RESULTS: Sixty-eight breasts in 39 patients underwent implant conversion. The most common primary indications for implant conversion were chronic pain (41%), animation deformity (30%), and cosmetic concerns (27%). Average BREAST-Q scores improved significantly preoperatively to postoperatively in all the domains measured ("satisfaction with breasts", "satisfaction with implants", "physical well-being," "psychosocial well-being," and "sexual well-being") (p<0.01). When examined by primary indication, all cohorts had significant preoperative to postoperative score improvement in "satisfaction with breasts" (p<0.001) and "physical well-being" (p<0.01) domains. Fifteen breasts (22%) developed postoperative complications, with implant loss in 9% of breasts. CONCLUSIONS: :Conversion of subpectoral implants to the prepectoral plane significantly improves BREAST-Q outcomes in all aspects, including patient satisfaction with breasts and implants, as well as psychosocial, physical, and sexual well-being. Implant conversion to the prepectoral plane in now becoming our primary solution to most patients with chronic pain, animation deformity or cosmetic concerns after subpectoral reconstruction.

Preparing for a Crowded Cosmetic Market: A Resident Training Model for Minimally Invasive Cosmetic Treatments.

SUMMARY: Patient demand for nonsurgical and minimally invasive cosmetic treatments has increased in recent years, resulting in a growing market that is particularly vulnerable to specialty creep. Despite this growing demand, nonsurgical cosmetic training for plastic surgery residents is often inconsistent and challenging. To ensure the continued safe and effective delivery of nonsurgical cosmetic care by board-certified plastic surgeons, it is critical to implement standardized training models for plastic surgery residents. In this Special Topic article, the authors describe their experience with a resident-run clinic training model that incorporates graduated autonomy, volunteer patient recruitment, and grant-based industry support that has been successfully implemented at their institution for the past 6 years. The article provides a framework for a resident educational model and addresses common obstacles in resident cosmetic training. The authors also provide recommendations for patient recruitment, optimizing clinic workflow, and the management of patient complications.

Plastic surgery and specialty creep: an analysis of publication trends.

BACKGROUND: Many surgical specialties have had pioneering influences from plastic surgeons. However, many of these areas of practice have evolved to include surgeons from diverse training backgrounds. This raises the question as to whether the prominence of other specialties in clinical practice translates to greater research productivity in these areas. The objective of this paper is to investigate the publication volumes of plastic surgeons in selected areas of practice compared to surgeons from other disciplines. METHODS: PubMed was used to examine publication trends in areas associated with plastic surgery. Searches for the following topics were performed: head and neck reconstruction, hand surgery, breast reconstruction, ventral hernia repair, abdominal component separation, brachial plexus injury, craniofacial surgery, and aesthetic surgery. Affiliation tags were used to examine contributions from nine specialties. Web of Science was used to identify the top cited articles for the last 10 years in each area. RESULTS: Articles by non-plastic surgeons comprise the majority of the literature for all areas of practice studied except for breast reconstruction and aesthetic surgery. Despite this, plastic surgeons contributed the greatest number of top cited articles over the last 10 years for five of the areas of practice. CONCLUSIONS: While plastic surgeons do not contribute the greatest proportion of articles published each year in several of the selected areas of practice, they do publish a larger number of articles that are the most cited. Plastic surgeons remain the dominant academic force in terms of volume and citations for both breast and aesthetic surgery.

Slowing the Spread and Minimizing the Impact of COVID-19: Lessons from the Past and Recommendations for the Plastic Surgeon.

BACKGROUND: Coronavirus disease 2019 (COVID-19), a novel coronavirus originating in December of 2019 in Wuhan, People's Republic of China, has spread rapidly throughout the globe over 3 months. On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. COVID-19 represents a nearly unprecedented threat to both the public health and the durability of our health care systems and will profoundly affect the field of plastic and reconstructive surgery. The objective of this article is to provide a natural history of COVID-19-including virology, epidemiology, and transmission patterns-and a guide for plastic surgeons regarding patient and resource management. METHODS: The authors reviewed existing literature regarding COVID-19, both primary research and secondary reviews, by means of PubMed queries, and recommendations from relevant professional organizations (e.g., American College of Surgeons and American Society of Plastic Surgeons). The literature and recommendations were summarized to provide a specific guide for plastic surgeons. RESULTS: Internationally, over 5.7 million cases and 357,000 deaths from COVID-19 have been reported at the time of writing. No pharmacologic treatments have been identified, but epidemiologic strategies were identified to prevent viral spread, preserve health care resources, and protect patients and surgeons globally. Specific recommendations for plastic and reconstructive surgeons include postponing elective cases and transitioning to telecommunication platforms for patient consultations and education. CONCLUSIONS: COVID-19 represents a nearly unprecedented threat to the public health and the durability of health care systems in the contemporary era. Although plastic and reconstructive surgery may seem relatively remote from the pandemic in direct patient care and exposure, our field can significantly enhance health care resource management.

A large-scale drug screen identifies selective inhibitors of class I HDACs as a potential therapeutic option for SHH medulloblastoma.

BACKGROUND: Medulloblastoma (MB) is one of the most frequent malignant brain tumors of children, and a large set of these tumors is characterized by aberrant activation of the sonic hedgehog (SHH) pathway. While some tumors initially respond to inhibition of the SHH pathway component Smoothened (SMO), tumors ultimately recur due to downstream resistance mechanisms, indicating a need for novel therapeutic options. METHODS: Here we performed a targeted small-molecule screen on a stable, SHH-dependent murine MB cell line (SMB21). Comprehensive isotype profiling of histone deacetylase (HDAC) inhibitors was performed, and effects of HDAC inhibition were evaluated in cell lines both sensitive and resistant to SMO inhibition. Lastly, distinct mouse models of SHH MB were used to demonstrate pharmacologic efficacy in vivo. RESULTS: A subset of the HDAC inhibitors tested significantly inhibit tumor growth of SMB21 cells by preventing SHH pathway activation. Isotype profiling of HDAC inhibitors, together with genetic approaches suggested that concerted inhibition of multiple class I HDACs is necessary to achieve pathway inhibition. Of note, class I HDAC inhibitors were also efficacious in suppressing growth of diverse SMO inhibitor‒resistant clones of SMB21 cells. Finally, we show that the novel HDAC inhibitor quisinostat targets multiple class I HDACs, is well tolerated in mouse models, and robustly inhibits growth of SHH MB cells in vivo as well as in vitro. CONCLUSIONS: Our data provide strong evidence that quisinostat or other class I HDAC inhibitors might be therapeutically useful for patients with SHH MB, including those resistant to SMO inhibition.

A Transposon Screen Identifies Loss of Primary Cilia as a Mechanism of Resistance to SMO Inhibitors.

Drug resistance poses a great challenge to targeted cancer therapies. In Hedgehog pathway-dependent cancers, the scope of mechanisms enabling resistance to SMO inhibitors is not known. Here, we performed a transposon mutagenesis screen in medulloblastoma and identified multiple modes of resistance. Surprisingly, mutations in ciliogenesis genes represent a frequent cause of resistance, and patient datasets indicate that cilia loss constitutes a clinically relevant category of resistance. Conventionally, primary cilia are thought to enable oncogenic Hedgehog signaling. Paradoxically, we find that cilia loss protects tumor cells from susceptibility to SMO inhibitors and maintains a "persister" state that depends on continuous low output of the Hedgehog program. Persister cells can serve as a reservoir for further tumor evolution, as additional alterations synergize with cilia loss to generate aggressive recurrent tumors. Together, our findings reveal patterns of resistance and provide mechanistic insights for the role of cilia in tumor evolution and drug resistance.Significance: Using a transposon screen and clinical datasets, we identified mutations in ciliogenesis genes as a new class of resistance to SMO inhibitors. Mechanistically, cilia-mutant tumors can either grow slowly in a "persister" state or evolve and progress rapidly in an "aggressive" state. Cancer Discov; 7(12); 1436-49. ©2017 AACR.See related commentary by Goranci-Buzhala et al., p. 1374This article is highlighted in the In This Issue feature, p. 1355.