Gender differences in the professional and private lives of plastic surgeons.

There are over 700 female members in the American Society of Plastic Surgeons. The purpose of this study was to assess possible differences between female and male plastic surgeons with respect to their practice characteristics, duration of practice, and some aspects of their private lives. We designed a 41 question survey to compare the practice features and personal demographics of female and male members of the American Society of Plastic Surgeons. A total of 1498 questionnaires were sent via e-mail to all female members (n = 687) and a random cohort of male members (n = 811). The respondents were age stratified by decade and their responses were compared by gender using chi tests. The overall response rate was 36.3%: 337 females (49%) and 207 males (25.5%) (P < 0.0001). Of female respondents, 35.3% were not married, as compared to only 12.5% of the males (P < 0.001). Additionally, 42.9% of women had no children, as compared to 11.5% of men (P < 0.001). Men also tended to have more children than their female counterparts, across all age groups. The majority of women (58.8%) delayed child-rearing until after residency, as compared to only 25.7% of men (P < 0.001). Male plastic surgeons were more than twice as likely as female plastic surgeons to earn an income greater than $400,000 per year (P < 0.001). Of 39 respondents who stated that they were no longer practicing, 21 (54%) were male and 18 (46%) were female (P = NS). Female plastic surgeons are significantly more likely to be unmarried, to postpone having children or be childless, as compared to their male counterparts. Furthermore, female plastic surgeons have a lower income than their male colleagues despite similar hours and practice profile. Nevertheless, female plastic surgeons appear to have similar career satisfaction and are no more likely to retire earlier or more frequently than male plastic surgeons.

Delayed division of the thoracodorsal nerve: a useful adjunct in breast reconstruction.

Breast reconstruction utilizing the latissimus dorsi musculocutaneous flap with an underlying breast implant is a well-established technique. Postoperative shoulder limitation is usually limited if at all noticeable. The muscle itself may, however, remain active in the new anterior position. Many patients find the muscle twitches with extension of the humerus, despite the anterior translocation of the muscle. This leads to a disturbing contraction, superolaterally, of the entire reconstruction. In addition, the resting tone can lead to a sense of tightness, despite a lack of clinically obvious capsular contracture. Division of the thoracodorsal nerve during initial flap elevation can prevent this problem. When raising the routine flap however, the pedicle itself is often not visualized and there is anxiety related to dividing the nerve and accidentally injuring the vascular pedicle. In addition, many of the transferred muscles atrophy, thereby avoiding this potential problem. When the muscle remains active, delayed division of the thoracodorsal nerve via a 2.5-cm axillary incision will stop the active twitching, decrease the resting tone of the muscle, and in most patients offer significant relief from symptoms of tightness. During the past 2 1/2 years, 100 latissimus dorsi flap breast reconstructions in 80 patients were performed. Forty-one nerves in 28 patients have been divided, with successful denervation in 37 of the 41 reconstructions, for a success rate of 90%. Delayed division of the thoracodorsal nerve can offer relief to patients complaining of tightness and muscle activity post-latissimus flap breast reconstruction.

Surgical management of scrotal lymphedema using local flaps.

Lymphedema affects all parts of the body, including the scrotum and penis. Genital lymphedema can be a functionally and emotionally incapacitating problem for patients. Patients suffer pain, chronic irritation, repeated infections, drainage, and sexual dysfunction. No ideal surgical or medical therapy exists for the treatment of male genital lymphedema. Fasciocutaneous thigh flaps have been used for coverage of the testes after scrotal lymphedema resection, but these flaps alter testicular thermoregulation and may cause infertility. Skin grafts have also been used for coverage. Use of posteriorly based perineal flaps may preserve perirectal lymphatics that provide collateral lymphatic drainage. We present 2 cases of severe scrotal lymphedema treated by lymphangiectomy and reconstruction with local flaps. Both patients were satisfied with their results and had improved quality of life. We present our miniseries of scrotal lymphedema treated by excision and anterior and posterior flap reconstruction as a successful treatment of this difficult problem.