Antenatal Breast Milk Expression Survey of Individuals Whose Pregnancy Was Complicated by Diabetes: Exploring Knowledge, Perceptions, Experiences, and Milk Volume Expressed.

OBJECTIVE: Antenatal breast milk expression (ABE) offers a host of benefits, including reduced formula consumption, support for breastfeeding success, and increased maternal satisfaction. Despite these advantages, experience with ABE differs significantly, often leading to anxiety over perceived inadequate milk supply and eventual breastfeeding cessation. This study comprehensively evaluates the knowledge, attitudes, and real-world experiences of individuals with gestational or pregestational diabetes concerning ABE, with a focus on total milk volume expressed prior to birth. STUDY DESIGN: Utilizing a convenience sampling method, we surveyed individuals with gestational or pregestational diabetes from three health care facilities who were trained in ABE. Knowledge and perceptions were gauged through presurvey statements, while postsurvey statements were employed to measure experiences, both using a 5-point Likert scale. In parallel, a retrospective study assessed both maternal and infant outcomes among the same participant pool. Statistical comparisons between individuals with and without reservations were made using the Wilcoxon signed rank sum, Mann-Whitney, chi-square, and Fisher's exact tests. RESULTS: Of the 138 participants, 75% completed both survey segments, and 61% expressed reservations about ABE. Both groups were demographically similar and showed comparable newborn outcomes. However, individuals with reservations experienced heightened pain during ABE, reported lesser lactation support, and were less willing to repeat the process compared to those individuals without reservations. The median total ABE volume was significantly lower by 14 mL among those with reservations (7 vs. 21 mL, p = 0.009). Although both groups demonstrated improved attitudes toward the utility of ABE for individuals with gestational or pregestational diabetes, no significant shift occurred in the perception of ABE difficulty. CONCLUSION: Our results indicate that individuals with gestational or pregestational diabetes who have reservations about ABE face unique challenges and tend to express lower milk volumes. This underlines the need for specialized interventions and ongoing research to address antenatal lactation support and alleviate ABE-related concerns among individuals with gestational or pregestational diabetes. KEY POINTS: · Reservations of ABE were associated with reduced milk volumes.. · Regardless of reservations, ABE was felt to be beneficial.. · Our results underscore the need for more ABE education for those with reservations..

Temperance With Tranexamic Acid: Increased Risk of Venous Thromboembolism in Abdominoplasty.

Tranexamic acid (TXA) is used widely in surgery to mitigate blood loss by inhibiting the fibrinolytic degradation of clots. The occurrence of venous thromboembolism (VTE) with TXA has not been reported in the plastic surgery literature. In the realm of plastic surgery, abdominoplasty has the highest rate of VTE. The purpose of this study is to report 5 cases of VTE with TXA. A single surgeon reviewed the records of 5 patients who incurred VTE with TXA. TXA was added to the tumescent fluid, 20 mg/kg total. Four of the 5 patients underwent abdominoplasty combined with liposuction and breast surgery, and the fifth, fat transfer to the breast. The abdominoplasty patients had received chemoprophylaxis. Upon presentation of symptoms, the patients were sent to the hospital for anticoagulation and hematology consultation. The 5 patients survived their VTE events; 2 only required oral anticoagulation, 2 required IV heparin then oral, and 1 required tissue plasminogen activator (tPA) then oral. VTE with abdominoplasty occurred in 0 of 399 cases prior to the use of TXA and in 4 of 98 cases after the use of TXA in the tumescent. Although the occurrence of VTE with abdominoplasty increased with the use of TXA for the senior author, this retrospective case study does not prove a causal relationship between TXA and VTE.

To Post or Not to Post: Plastic Surgery Practice Marketing, Websites, and Social Media?

Social media is beginning to eclipse practice websites and other traditional electronic marketing utilized by plastic surgeons. First, highlights are presented from the relevant electronic marketing literature. Next, this article presents a new case study of how, why, when, and what social media is being used by ASPS members (n = 100). Results suggest a significant disconnect between plastic surgeons and the highest impact platforms reported in the literature such as Instagram, YouTube, Snapchat, and Facebook. Plastic surgeons currently prefer to focus electronic marketing efforts on practice websites over social media platforms. This study suggests that instead of relying on their practice websites to disseminate information, surgeons should be utilizing social media, posting promotions, before-and-after photos, and videos to develop their client base.

Lipoaugmentation following Implant Removal Preferred by Plastic Surgeons and the General Public.

BACKGROUND: Breast implant removal followed by fat transfer to the breast (lipoaugmentation) is a newer procedure and as such there is a need for empirical aesthetic comparisons between breast augmentation with implants versus fat transfer. Fat transfer to the breast is becoming an important option for women seeking reoperation of breast augmentation. METHODS: A survey was created using standardized before and after photographs of 12 patients who underwent implant removal and lipoaugmentation. Four photographs of breasts that had no surgery were used as controls, with identical before/after photographs. The survey was administered to 96 respondents from the general population and 10 plastic surgeons. Respondents were asked to rate the breasts using a 5-point Likert scale without procedural knowledge. The responses were evaluated using parametric statistical t tests to compare responses to implants versus fat transfer in terms of their respective attractiveness, naturalness, size, symmetry, and femininity. RESULTS: Fat transfer was significantly preferred to implants on all 5 measures; attractiveness, naturalness, size, symmetry, and femininity. Fat transfer was significantly preferred to implants by a margin of +0.36 average on 1-5 scale, which is approximately 1/3 of a Likert interval on all measures. Plastic surgeons took significantly longer than the general population to complete the survey and preferred fat transfer over implants to a higher degree. CONCLUSIONS: Lipoaugmentation can provide a favorable aesthetic outcome in women seeking implant removal. The general public can be conveniently surveyed via crowd sourcing, and their aesthetic judgments largely mirror those of trained and experienced plastic surgeons. Patients weighing breast implant removal or breast implant revision could consider this study in their decision making.

Lower Face Rejuvenation with Injections: Botox, Juvederm, and Kybella for Marionette Lines and Jowls.

A 55-year-old woman requesting noninvasive rejuvenation of the lower face received multimodal injections in a single office visit to rejuvenate the jowls. The patient experienced no adverse events other than self-limiting bruising at the hyaluronic acid injection site and minimal edema. The outcomes were evaluated as follows: (1) by the patient using the self-rated Face-Q assessment and (2) by 5 plastic surgeons (none of whom were the author of this study) based on the WAS scale and before and after photographs to evaluate the corners of the mouth and the marionette lines. This case study report suggests that the combined use of neuromodulator, hyaluronic acid dermal filler, and synthetic deoxycholic acid can rejuvenate the lower face as a minimally invasive alternative to surgery to the satisfaction of the patient and 6 plastic surgeons (including the author).

Ineffective treatment of keloids with interferon alpha-2b.

BACKGROUND: Keloids are exuberant, disfiguring scars that result from an abnormal healing process. Current established treatment strategies include surgical resection, triamcinolone steroid injection, pressure therapy, silicone therapy, and radiotherapy. None of these therapies, either alone or in combination, offers consistent recurrence-free rates above 70 to 80 percent. The antiproliferative, antifibrotic cytokine, interferon alpha-2b, may be useful in keloid management because of its ability to interfere with collagen synthesis and fibroblast proliferation. METHODS: To determine the efficacy of interferon alpha-2b in keloid management, the authors prospectively evaluated the effects of interferon alpha-2b as postexcisional adjuvant therapy for keloids. Thirty-nine keloids in 34 patients were photographed, measured, and surgically excised. The wound bed was injected twice with either interferon alpha-2b (treatment group; n = 13 keloids) or triamcinolone (control group; n = 26 keloids) at surgery and 1 week later. The patients were followed up in the plastic surgery clinic. RESULTS: The trial protocol was terminated at midtrial surveillance. Among the 13 keloids that were treated with postoperative intralesional interferon alpha-2b, seven recurred (54 percent recurrence rate). In contrast, in the 26 keloids that received triamcinolone (control group), only four recurred (15 percent recurrence rate). Recurrence in either group did not correlate with location of the keloid or race. CONCLUSION: Interferon does not appear to be effective in the clinical management of keloids.

Keloid pathogenesis and treatment.

BACKGROUND: Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood. METHODS: Using original and current literature in this field, this comprehensive review presents the major concepts of keloid pathogenesis and the treatment options stemming from them. RESULTS: Mechanisms for keloid formation include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Treatment strategies for keloids include established (e.g., surgery, steroid, radiation) and experimental (e.g., interferon, 5-fluorouracil, retinoid) regimens. CONCLUSION: The scientific basis and empiric evidence supporting the use of various agents is presented. Combination therapy, using surgical excision followed by intradermal steroid or other adjuvant therapy, currently appears to be the most efficacious and safe current regimen for keloid management.

Implantable baclofen pump as an adjuvant in treatment of pressure sores.

Currently, the success of ulcer treatment is limited by the high recurrence and complication rates. Spasticity is an important contributing factor to ulcer recurrence, and intrathecal baclofen is an effective method to reduce spasticity. Spasticity creates friction, shear, and mobility impairment resulting in wound dehiscence, flap loss, infection, and hematoma. Spasticity can be managed pharmacologically and surgically; baclofen is the drug of choice. Baclofen inhibits spasticity by blocking excitatory neurotransmitters in the spinal dorsal horn. Intrathecal baclofen maximizes the dose delivered to spinal receptors and minimizes the side effects associated with oral baclofen. Case reports of intrathecal baclofen used in patients with pressure sores demonstrate the use of intrathecal baclofen to improve reconstructive outcomes in spastic patients.