Can AI Answer My Questions? Utilizing Artificial Intelligence in the Perioperative Assessment for Abdominoplasty Patients.

BACKGROUND: Abdominoplasty is a common operation, used for a range of cosmetic and functional issues, often in the context of divarication of recti, significant weight loss, and after pregnancy. Despite this, patient-surgeon communication gaps can hinder informed decision-making. The integration of large language models (LLMs) in healthcare offers potential for enhancing patient information. This study evaluated the feasibility of using LLMs for answering perioperative queries. METHODS: This study assessed the efficacy of four leading LLMs-OpenAI's ChatGPT-3.5, Anthropic's Claude, Google's Gemini, and Bing's CoPilot-using fifteen unique prompts. All outputs were evaluated using the Flesch-Kincaid, Flesch Reading Ease score, and Coleman-Liau index for readability assessment. The DISCERN score and a Likert scale were utilized to evaluate quality. Scores were assigned by two plastic surgical residents and then reviewed and discussed until a consensus was reached by five plastic surgeon specialists. RESULTS: ChatGPT-3.5 required the highest level for comprehension, followed by Gemini, Claude, then CoPilot. Claude provided the most appropriate and actionable advice. In terms of patient-friendliness, CoPilot outperformed the rest, enhancing engagement and information comprehensiveness. ChatGPT-3.5 and Gemini offered adequate, though unremarkable, advice, employing more professional language. CoPilot uniquely included visual aids and was the only model to use hyperlinks, although they were not very helpful and acceptable, and it faced limitations in responding to certain queries. CONCLUSION: ChatGPT-3.5, Gemini, Claude, and Bing's CoPilot showcased differences in readability and reliability. LLMs offer unique advantages for patient care but require careful selection. Future research should integrate LLM strengths and address weaknesses for optimal patient education. 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 .

Injection Treatments for Vulvovaginal Atrophy of Menopause: A Systematic Review.

BACKGROUND: Injection treatments have been proposed as novel treatment options for Vulvovaginal Atrophy of Menopause (VVA) also known as Genitourinary Syndrome of Menopause (GSM). However, to date data about these treatments are poor. OBJECTIVE: To assess all available injection treatments for VVA. METHODS: A systematic review was performed by searching five electronic databases for peer-reviewed studies that assessed injection treatments for VVA. RESULTS: Eight studies (7 observational and 1 randomized) with 236 women were included. Assessed injection materials were: autologous platelet-rich plasma (PRP) + hyaluronic acid (HA), not cross-linked HA plus calcium hydroxyapatite (NCLHA + CaHA), micro-fragmented adipose tissue (MFAT), hyaluronan hybrid cooperative complexes (HCC), crosslinked HA, microfat and nanofat grafting + PRP, and PRP alone. Improvement in GSM symptoms after treatment was assessed through Visual Analogic Scale (VAS) for GSM symptoms or patient satisfaction, several validated questionnaires (FSFI, VHI, FSD, SF12, ICIQ UI SF, PGI-I, FSDS-R, VSQ), symptoms severity, changes in vaginal mucosa thickness, flora, pH, and expression on vaginal mucosal biopsies of Procollagen I and III and ki67 immunofluorescence or COL1A1 and COL3A1 mRNA. Injection treatments showing significant improvement in GSM-related symptoms were: (i) HCC in terms of VAS for GSM symptoms and FSFI score; (ii) Crosslinked HA in terms of VAS for GSM symptoms, FSFI and VHI score, COL1A1 and COL3A1 mRNA expression on vaginal mucosal biopsies; (iii) NCLHA + CaHA in terms of FSFI score; (iv) PRP + HA in terms of VHI, FSD and SF12 score; (v) microfat and nanofat grafting + PRP in terms of VHI score and FSDS-R score; (vi) PRP alone in terms of VHI and VSQ scores. CONCLUSIONS: All assessed injection treatments except for MFAT seem to lead to significant improvement in VVA symptoms on validated questionnaires. Further studies are necessary in the field. LEVEL OF EVIDENCE II: 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 .

Metastatic Renal Cell Carcinoma to the Soft Tissue 27 Years after Radical Nephrectomy: A Case Report.

Background and Objectives: Approximately 20-40% of patients affected with renal cell carcinoma (RCC) develop either distant metastatic or locally recurring disease following radical nephrectomy. Soft tissue, skin, and the central nervous system are less common metastatic sites. We present the case of a patient who has received a diagnosis of RCC; it was found that she had no metastases at the time of nephrectomy but had metastases in the soft tissue and subcutaneous tissue of the scalp 27 years later. As far as we can tell, this is the longest period elapsed between primary renal tumor and subcutaneous/soft tissue metastasis; moreover, this case is the first report of a combined soft tissue/subcutaneous metastasis from RCC. Case presentation: A 73-year-old woman underwent right radical nephrectomy 27 years earlier for clear cell renal cell carcinoma (CCRCC). She presented at our unit because she noticed swelling in the left temporal region; after radiological exams, a benign lesion was suspected. The patient underwent surgical eradication, but the massive bleeding did not allow the removal of the lesion. A biopsy of the mass was performed and the histological examination was consistent with RCC metastases. Conclusions: Metastases from renal cell carcinoma to the subcutaneous and soft tissues are rare. It is essential to take into account RCC metastases in the differential diagnostic of the new starting mass of the head and neck, and the necessity for close and continuous surveillance of patients diagnosed with renal cancer even after a long disease-free period should be emphasized.

Reply to De Luca et al. Comment on "Marra et al. Metastatic Renal Cell Carcinoma to the Soft Tissue 27 Years after Radical Nephrectomy: A Case Report. Medicina 2023, 59, 150".

We appreciated the comments of De Luca and colleagues [...].

Atypical cytological presentation of granular cell tumour: Tumour-associated fibrosis may affect fine-needle aspiration cytology accuracy.

The cytological features of granular cell tumour (GCT) are generally quite typical but, in some cases, the fine needle aspiration cytology (FNAC) diagnosis of GCT may be difficult or impossible because of unusual sites of onset or equivocal cytological features. In this report, two GCTs with atypical FNAC features are described in order to investigate the causes and provide possible diagnostic tips. From a series of nine histologically proven GCTs, two inconclusive FNAC cases were retrieved. Smears were poorly cellular showing isolated naked nuclei, anisonucleosis, granular chromatin and occasional small nucleoli. The background was finely granular in one case. Histological controls of these cases revealed marked fibrosis. Tumour-associated fibrosis in GCT is variable and does not seem to influence clinical behaviour but it influences the harvest and the integrity of granular cells collected by FNAC. When GCT smears are poorly cellular, attention should be paid to the granular background and to the few granular cells, if any, as they might be the only features to suggest a GCT.

Effects of Prophylactic Lipofilling After Radiotherapy Compared to Non-Fat Injected Breasts: A Randomized, Objective Study.

BACKGROUND: Patients who are suffering from invasive breast cancer may require post-mastectomy radiation therapy (PMRT). PMRT improves outcomes in breast cancer patients in terms of locoregional recurrence. Preliminary studies indicate that fat injections reduce post-radiation damage of soft tissue and implants. OBJECTIVES: The aim of this study was to demonstrate the safety and effectiveness of prophylactic fat injections on radiated implanted breasts. METHODS: The authors randomly assigned 60 female patients to either Group A or B. Group A patients received 3 breast fat injections, according to Coleman's technique, after radiotherapy and before expander removal with definitive implant insertion. Group B patients underwent surgery without lipofilling. At each surgical operation, skin biopsies were performed in a specific breast area to evaluate adipose tissue thickness, and a statistical analysis of the thickness variations was performed with the Wilcoxon's sum test. Disability was assessed according to the Late Effects of Normal Tissues-Subjective Objective Management Analytic scale. RESULTS: The study demonstrates a qualitative and quantitative improvement about tissues after fat injection. This is highlighted by the significant increase in thickness after lipofilling. CONCLUSIONS: The study, which is based on both clinical and histological findings and is supported by the comparison of a control group with a 1-year follow-up, demonstrates that fat injections reduce tissue radio damage, improving reconstructive surgery outcomes and quality of life.

Oculonasal Synkinesis: Video Report and Surgical Solution of a Rare Phenomenon.

BACKGROUND: Synkinesis represents involuntary muscular movements that occur in association with voluntary contraction of other muscle groups. Oculonasal synkinesis is a rare phenomenon. OBJECTIVES: In a series of videos, the authors present clinical findings and surgical correction of oculonasal synkinesis. METHODS: Two women who underwent surgical procedures to correct oculonasal synkinesis were evaluated in a prospective study. One patient presented with bilateral synkinesis after 2 previous rhinoplasties. She underwent open rhinoplasty in our office. The other patient had unilateral synkinesis of the left side and received endonasal rhinoplasty. RESULTS: The patients' mean age was 27.5 years, and follow-up was conducted for 6 months. Both patients experienced complete, stable resolution of synkinesis after surgical correction. No complications were recorded. CONCLUSIONS: Patients with oculonasal synkinesis may not notice it preoperatively and may regard these muscle movements as an unfavorable result of rhinoplasty. Therefore, careful preoperative evaluation is crucial.

Evidence-based evaluation technique to assess augmentation mammaplasty results: a simple method to objectively analyze mammary symmetry and position.

BACKGROUND: Despite the great variety of mammaplasty techniques, outcome assessment remains a challenging issue. OBJECTIVES: The authors devised an objective method to evaluate mammary symmetry based on statistical analysis of objective manual breast measurements and validated the method by applying it to results of a randomized controlled trial on the correction of breast asymmetry. METHODS: Sixty consecutive patients with hypoplastic breasts and small-volume asymmetry were enrolled in the study and randomly assigned to 1 of 2 groups. One group received a fixed-volume implant in 1 breast and an adjustable-volume implant in the other. The other group received 2 fixed-volume implants of different sizes. The differences in specific breast and chest measurements, obtained before surgery and during follow-up, were analyzed statistically with the Wilcoxon signed rank test. RESULTS: Correction of the asymmetry resulted in the reduction of the differences between left and right values for each specific breast measurement. Placement of an adjustable implant on 1 side yielded better symmetry than placement of 2 fixed-volume prostheses of different sizes. Patient and physician satisfaction was high for both groups. CONCLUSIONS: This objective analysis of clinical parameters enables comparing results for different patients in large clinical trials and for the same patient at different follow-up periods. LEVEL OF EVIDENCE: 3.

Acellular dermal matrix in breast augmentation surgery: A systematic review.

Background: The use of acellular dermal matrix (ADM) in breast reconstruction was described for the first time in 2000s. Recently, ADMs have been used not only in reconstructive surgery but also in cosmetic breast surgery for both primary and revision indications. Therefore, the matrices represent an important support to recent surgical techniques for breast augmentation in treatment or prevention of complications. Conversely, ADMs can affect operative times, costs, and additional complications related to their placement. A review of the literature was carried out to evaluate the efficacy, safety, and indication for the use of these matrices in cosmetic breast surgery. Methods: A literature review was conducted including manuscripts published up to April 2023 on breast augmentation using ADM. PubMed and MEDLINE were the databases used for research. The keywords used were "Breast augmentation" and "Acellular Dermal Matrix." Non-English language articles have been excluded. Results: The initial search for "breast augmentation" yielded 7900 results, which were further reviewed for "Acellular Dermal Matrices" in breast augmentation, selecting 74 articles. Following further screening, 12 articles were included in the review. A total of 787 patients were treated with breast augmentation and ADM placement. The main indication was capsular contracture (60%). Conclusions: The current evidence from the published scientific literature, albeit limited, suggests the indication for the use of ADM in revision surgery, to support the prosthetic pocket, to minimize the risk of capsular contracture and its recurrence.

Lower Extremity Trauma: A Multidimensional Reconstructive Approach with Hyperbaric Oxygen Therapy.

Background: Distal lower extremity reconstruction is challenging. This study aims to propose a protocol for the treatment of traumatic soft tissue defects. The key concept is to combine the surgical armamentarium of the reconstructive surgeon with the advantages provided by hyperbaric oxygen therapy. Methods: This retrospective study analyzed data of 57 patients affected with unilateral or bilateral lower extremity trauma distal to the knee and involving soft tissues with no indication of immediate reconstruction between 2010 and 2021. Before the reconstructive procedure, all the patients underwent a stick swab procedure for the collection of microbiological samples and debridement. Patients were divided into two treatment groups and only one group underwent a combined therapeutic procedure with hyperbaric oxygen therapy. Negative pressure wound therapy (NPWT) was employed only if deemed necessary according to the defect's depth and wound exudate. Surgical techniques, outcomes, and complications were discussed. Results: All patients achieved a complete recovery with no major complications and only minor complications observed. The study group treated with HBOT had a lower complication rate and lower percentages of minimal and partial graft loss compared with the same complications observed in the control group. No patients experienced HBOT-related complications. Significant reductions in the time to complete healing and the time from reconstruction to healing were found (p = 0.002 and p < 0.00001, respectively). Conclusions: A lower complication rate was observed in the group treated with HBOT. The administration of HBOT prior to soft tissue reconstruction significantly reduced the time to complete healing and the time interval from skin grafting to healing. However, prospective studies and randomized trials with larger cohorts should be designed to investigate the efficacy of HBOT for the treatment of lower extremity injuries with extensive soft tissue defects.

Lower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients.

BACKGROUND: Lower lip reconstruction is crucial to restore oral integrity post-cancer excision. A perfect balance between form and function should be achieved. With an aging demographic, adapting surgical methods to meet the unique needs of the elderly becomes imperative. Our study aims to introduce a specialized algorithm for lower lip reconstruction; it was tailored to geriatric patients and emphasized the use of "simpler flaps". Additionally, "Pearls and Pitfalls" were provided for surgeons approaching lower lip reconstruction. METHODS: Between January 2018 and June 2021, a retrospective study was carried out. Data collection included patient demographics, defect attributes, reconstructive approaches, flap viability assessment, wound healing, and complications. The follow-up was carried out for a period of a minimum of 6 months. RESULTS: Among 78 patients, squamous cell carcinoma predominated with a mean defect area of 3308 cm2. Postoperative complications were recorded in two patients. All patients reported sensory restoration and overall satisfaction at the 6-month follow-up; secondary procedures were not necessary. CONCLUSION: Our reconstructive algorithm, focused on elderly patients, prioritizes less invasive reconstructive techniques and introduces innovative modifications to the established methods to achieve both aesthetic and functional outcomes with a low complication rate. In patients undergoing lower lip reconstruction, the subjective microstomia was found to be less relevant than the objective microstomia.

Human Papillomavirus-Associated Giant Clear Cell Acanthoma and Squamous Cell Carcinoma: A Rare Case Report and Literature Review.

Clear cell acanthoma (CCA) and squamous cell carcinoma (SCC) represent distinct entities within dermatological oncology, each posing unique diagnostic and therapeutic challenges. CCA is a rare, benign epidermal growth, often not associated with human papillomavirus (HPV) infection, whereas SCC, a more aggressive form of skin cancer, has been linked to both ultraviolet (UV) exposure and HPV. Understanding the co-occurrence of these conditions in a single patient can enhance diagnostic accuracy and therapeutic outcomes. We report a 64-year-old male who underwent an operation for a verruciform lesion in the right groin, which was diagnosed as HPV-positive CCA alongside keratinised SCC. A literature search across January 2024 revealed limited evidence directly linking HPV to CCA, suggesting a need for further investigation. The speculative association between HPV and CCA warrants deeper exploration, especially considering the potential for HPV to contribute to lesion development through indirect mechanisms. The coexistence of CCA and SCC in an elderly patient presents a unique clinical scenario. This emphasises the need for vigilant diagnosis and tailored treatment strategies, highlighting the gap in understanding the pathogenesis of CCA, particularly its potential association with HPV. Further research is crucial for elucidating the complex interactions governing these conditions and for developing targeted interventions.

Surgical treatment of upper eyelid coloboma: our experience.

AIM: The purpose of this paper is to evaluate the results obtained in the surgical treatment of upper eyelid coloboma with methods that do not involve a prolonged occlusion of the eye. MATERIAL OF STUDY: We treated five patients aged between 7 months and 21 years; the surgical techniques adopted were the direct closure (2 patients), the full-thickness graft from the contralateral upper eyelid (2 patients) and the nasal chondromucosal flap (1 patient). RESULTS: The results were good in all patients with vitality of all grafts and flaps; also absent were hematomas, seromas and infections. None of the patients developed amblyopia and lagophthalmos. DISCUSSION: The use of these methods prevents the development of some complications, such as amblyopia, occurring with the use of other techniques, as shown in the literature. In addition, allowing the reconstruction with similar tissues or very flexible and thin tissues provides greater functionality to the new eyelid. CONCLUSIONS: When possible, early intervention with the use of the described techniques will provide good results in the short and long term, allowing to avoid minimal complications which may arise from a prolonged occlusion of one eye.

[Treatment of ulcer and difficult wounds of the lower limbs: our experience]. / Trattamento delle ulcere e delle ferite difficili dell'arto inferiore. Nostra esperienza.

AIM: The purpose of this study is to evaluate the results obtained using traditional and advanced dressings, platelet gel, vacuum therapy and surgical techniques (grafts, flaps and dermal substitutes) in the treatment of ulcers and difficult wounds of the lower limbs to determine a treatment algorithm. MATERIAL OF STUDY: From January 2006 to September 2010 were performed 428 treatments on 377 patients (203 men and 174 women, age between 32 and 90 years). Both medical and surgical treatments were performed: 61 traditional medications, 149 advanced dressings, 25 with platelet gel, 42 with the vacuum therapy, 16 with surgical debridement, 86 with skin grafts of varying thickness, 8 with dermal substitutes and 42 with surgical flaps. RESULTS: The best results were obtained with the most innovative methods, which showed, on average, a higher healing rate compared to traditional medications. Positive results were also obtained with surgical treatment if properly preceded by a correct wound bed preparation. CONCLUSION: The main characteristic that should guide the choice of therapy is the clinical appearance of the lesion: correct management of all its aspects allows to increase the rate of healing and, when necessary to have recourse to less invasive surgical procedures.

Reconstruction of the loss of substance of the dorsum of the hand: from the conventional techniques to regenerative surgery procedures.

AIM: Our aim is focused on the advantages of new technologies compared with those of traditional methods in the reconstruction of the loss of substance of the dorsum of the hand. MATERIAL OF STUDY: We observed 37 patients from 2007 to 2010 with loss of substance of the dorsum of the hand, also associated with significant comorbidities. In 27 patients we chose surgical reconstruction, in 10 patients we opted for conservative reconstruction with the use of new technologies. RESULTS: After a median follow-up from one to three years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction. DISCUSSION: Concerning reconstruction by means of flaps, the main principles dictate is the new coverage must appear as much as possible, similar to the original tissue. The reconstruction must be in a single surgical time. On the other hand, the advent of advanced dressings and bioengineering has optimized conservative skin repair. CONCLUSIONS: We have seen a considerable broadening of the indications for conservative reconstruction. This method is suitable for reconstruction of the dorsum of the hand with good effectiveness, it makes it possible to obtain a tissue of good quality, which is flexible and smooth on the tendons and is not excessively thick. These methods are achieved with relative ease even in patients with poor general health. Although costly, this procedure will ultimately save the patient from further surgeries and hospitalization expenses, making it advantageous when considering the benefit-cost ratio.

Cephalic traumas with lacrimal apparatus involvement. Our experience.

PURPOSE: The involvement of the lacrimal ducts in the extreme cephalic trauma is an infrequent condition. A correct diagnosis and appropriate management of injuries of the lacrimal system are essential to prevent the onset of post-traumatic epiphora. METHODS: In the last 5 years, 37 patients were treated for lacrimal apparatus injury as a result of cephalic trauma: in 16 there was an isolated lacrimal injury and in 21 were documented fractures combined with lacrimal damage. RESULTS: In 16 patients who had only deep lesions, was performed a reconstruction after location lesion localization, and only in 4 cases, because of the gravity of the lesion, it was decided to perform a reconstruction in a second time. In the remaining 21 patients the facial fractures were treated before lacrimal injuries, whose reconstruction was carried out on a second time. CONCLUSIONS: The reconstruction of the cephalic district has to be based on the restoration of morpho-functional component and on the identification and treatment of lacrimal injuries. The reduction of fractures in our view should start from the lateral area (centripetal reconstruction) allowing to have a guide for alignment of the fracture lines. The objectives to be achieved in a facial trauma are therefore three: the maintenance of vital functions, the recovery of the function and the restoration of morphological and functional prior to the event.

[Reconstruction of full-thickness loss of substance of lower lip. Our experience]. / Ricostruzione delle perdite di sostanza a tutto spessore del labbro inferiore Nostra esperienza.

AIM: Many methods have been described for the reconstruction of the lower lip, but each has its own advantages and its disadvantages. The purpose of this study is to evaluate the results obtained with the use of different methods in order to choose the most appropriate method, according to the characteristics of the loss of substance. METHODS: From January 2006 to March 2011 were treated 110 patients with full-thickness loss of substance of the lower lip using various techniques: direct closure in small losses of substance (20 patients), Abbe flap (14 patients), Johanson technique (12 patients), Gillies fan flap (9 patients), Estlander flap (8 patients), Mc Gregor flap (11 patients), Karapandzic flap (18 patients), the nasolabial flap by Von Bruns (10 patients) and Bernard-Burow flap modified by Webster (8 patients). RESULTS: All flaps were vital and there were no cases of necrosis, infection, seromas or hematoma. Among the main complications, there was a delay in wound healing in 11 patients and the development of microstomia, of variable degrees, in 9 patients. The results from the aesthetic point of view were between good and satisfactory. CONCLUSIONS: The extension of the loss of substance is the main criterion that should direct the choice of an appropriate surgical technique: for larger defects reconstruction is less than optimal and obtain an adequate sphincter function is the main goal to achieve also with the use of near tissue.

Clinical Evaluation of the Efficacy and Tolerability of Rigenase® and Polyhexanide (Fitostimoline® Plus) vs. Hyaluronic Acid and Silver Sulfadiazine (Connettivina® Bio Plus) for the Treatment of Acute Skin Wounds: A Randomized Trial.

OBJECTIVES: Compare the efficacy and tolerability of Connettivina® Bio Plus (Group A) gauze and cream, and Fitostimoline® Plus (Group B) gauze and cream for the treatment of acute superficial skin lesions. DESIGN: Single-center, parallel, randomized trial. A block randomization method was used. SETTING: University of Salerno-AOU San Giovanni di Dio e Ruggi d'Aragona. PARTICIPANTS: Sixty patients were enrolled. All patients fulfilled the study requirements. INTERVENTION: One application of the study drugs every 24 h, and a six-week observation period. MAIN OUTCOME MEASURES: Efficacy and tolerability of the study drugs. RESULTS: In total, 60 patients (Group A, n = 30; Group B, n = 30) were randomized; mean age was 58.5 ± 15.8 years. All patients were included in the outcome analysis. Total wound healing was achieved in 17 patients undergoing treatment with Connettivina® Bio Plus and 28 patients undergoing treatment with Fitostimoline® Plus. The greater effectiveness of the latter was significant (p = 0.00104). In Group B, a significantly greater degree of effectiveness was observed in reducing the fibrin in the wound bed (p = 0.04746). Complications or unexpected events were not observed. CONCLUSIONS: Both Connettivina® Bio Plus and Fitostimoline® Plus are secure and effective for treating acute superficial skin lesions. Fitostimoline® Plus was more effective than Connettivina® Bio Plus in wound healing of acute superficial skin lesions, especially if fibrin had been observed in the wound bed.

A multicentre study of the relationship between abdominal flap and mastectomy weights in immediate unilateral free flap breast reconstruction and the effect of adjuvant radiotherapy.

Abdominal free flaps are considered the gold standard for post-mastectomy autologous breast reconstruction. A key element of outcome assessment is breast symmetry often achieved by approximating the reconstructed breast dimensions such as weight (wt) to those of the mastectomy. However, the ideal relationship between these two entities remains unclear. 525 immediate unilateral abdominal free flap breast reconstruction (FFBR) patients were enrolled in a multicentre study (UK 141; Italy 384) and subdivided into Group A (flap wt < mastectomy wt, n = 163), Group B (flap wt > mastectomy wt, n = 260) and Group C (flap wt = mastectomy wt, n = 102). Their rates of contralateral balancing and ipsilateral revision surgeries were compared using Chi-Square tests. Radiotherapy influence on these adjustment procedures was also assessed. More contralateral balancing procedures (17%) were performed than ipsilateral revisions (10%). Group A rates of contralateral balancing procedures were three times higher than Group B's with a ratio of 37 to 1 versus Group C (37% vs 11% vs 1% respectively, p < 0.001). Similarly, the ipsilateral breast revision surgery rate in Group A was double that of Group B and almost three times that of Group C (17% vs 8% vs 6% respectively, p = 0.01). Adjuvant radiotherapy disproportionately increased ipsilateral revisions versus contralateral balancing surgeries (p = 0.028). A flap-to-mastectomy weight ratio of less than 1 (Group A) significantly increases subsequent adjustments on both contralateral and reconstructed breasts whilst irradiation predisposes to ipsilateral revisions. This is important in patient counselling and intraoperative flap contouring. Flap weight should ideally approximate or exceed mastectomy weight in unilateral FFBR.