Research Productivity of Integrated Plastic Surgery Residents: Does Reputation Matter?

INTRODUCTION: It is unknown whether the ranking of plastic surgery residency programs influences resident research output. This study aims to determine whether program reputation and other factors are associated with integrated plastic surgery resident academic productivity. MATERIALS AND METHODS: Programs were divided into four tiers based on Doximity reputation rankings. Residents from 2019 to 2020 were found through program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year to August 10, 2020. Variables included resident demographics and medical school, residency reputation ranking, geographic region, and medical school affiliation. 'High research output' was defined as having ≥75th percentile of publications adjusted by training year. RESULTS: In total, 921 residents in 80 programs were identified. The median (IQR) number of total publications and original articles was 3 (1-6) and 2 (0-4), respectively. On multivariable analysis, residents in top-20 ranked programs (OR = 2.31, 95% CI [1.55; 3.43], P < 0.001) or from programs associated with top-20 medical schools (OR = 1.61, 95% CI [1.08; 2.41], P = 0.020) were more likely to have higher research output. On the other hand, coming from a top-50 in research medical school (OR = 1.80, 95% CI [1.31; 2.47], P < 0.001) or being in a program affiliated with a top-20 medical school (OR = 2.52, 95% CI [1.69; 3.78], P < 0.001) were associated with higher original article output. Gender and geographic location were not associated with higher research output. CONCLUSIONS: Program reputation and affiliated medical school research rankings are associated with research productivity during integrated plastic surgery residency. Applicants with a particular interest in research careers may consider this as they apply to residency.

Interest in Plastic Surgery Residency: A Google Trends Analysis.

BACKGROUND: Since 2010, the number of programs and available positions for integrated plastic surgery residency has increased, yet the match rate remains one of the lowest of all specialties, and the applicant pool remains one of the most competitive. We sought to investigate whether this increased interest in integrated programs has translated to increased online search volume regarding plastic surgery residency. METHODS: Our study uses Google Trends, a powerful online tool that analyzes changes in Google search volume over time and across various regions, to study temporal and geographic trends in search interest for terms related to plastic surgery residency from July 2009 to 2020 in the United States. RESULTS: Terms related to plastic surgery research, step 1 and 2 scores, and residency interviews had the most search results, whereas terms related to away rotations and Alpha Omega Alpha had the least. "Independent plastic surgery track" had more total search results on Google than "integrated plastic surgery residency," and "plastic surgery fellowship" declined in search interest from July 2009 to March 2010. There was a rise in search volume for a plastic surgeon's salary and a fall in search volume for plastic surgery research between July 2009 and July 2020. However, other terms related to residency or residency applications showed no sustained trends over time. "Plastic surgery residency" was most searched in Pennsylvania, New York, Ohio, and Missouri, whereas "plastic surgeon salary" was most searched in Louisiana, Texas, Arizona, and Georgia. CONCLUSIONS: This Google Trends analysis showed discordance between the upward trend in integrated plastic surgery residency positions offered through the National Residency Match Program and relatively unchanging search interest in factors related to the plastic surgery residency application. However, interest in a plastic surgeon's salary has increased over time, but this is not specific to plastic surgery. Although online search tools can be of important predictive value, this study demonstrates that there are clearly other factors that influence medical students' interest in plastic surgery residency besides Internet research.

A Social Media Analysis of Wellness Culture in Plastic Surgery Residency.

BACKGROUND: Burnout, "a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment", afflicts approximately one third of plastic surgery attending surgeons and residents. Burnout can be detrimental to resident training and patient outcomes. Therefore, cultivating wellness during residency is essential. In fact, the Accreditation Council for Graduate Medical Education requires residency programs to create learning and working environments that optimize faculty and resident wellness. With increasing social media use by plastic surgery residency programs, this study aimed to analyze their posts for wellness-related content. METHODS: Integrated plastic surgery residency programs were obtained from the American Council of Academic Plastic Surgeons Web site, and their associated social media accounts were identified. The authors reviewed all post images, captions, and comments made by the program's account, until July 3, 2021. Any hashtags relating to wellness were also recorded. RESULTS: Of 82 programs, 76 (92.7%) had active Instagram accounts, 31 (37.8%) had active Facebook accounts, and 30 (36.6%) had active Twitter accounts. Instagram had higher rates of engagement than Facebook and Twitter (P < 0.001). Across all platforms, the mean percent of total posts related to wellness was 18.87%. The most common wellness content showcased resident work-life balance (48.73%), followed by educational events incorporating wellness activities (27.61%), attention to physical health (17.71%), healthy work environments (5.29%), wellness-specific activities (3.25%), team building activities (2.40%), and images implying but not directly showing resident wellness (1.46%). Programs did not vary significantly in percentages of total posts related to wellness by geographic region, ranking, or accreditation length. In total, 1893 wellness-related hashtags were used on Instagram, 253 on Facebook, and 72 on Twitter. The most used wellness-related hashtag was #residentlife. Only 40.8% to 50.8% of posts using wellness hashtags met at least 1 wellness criterion. CONCLUSION: Despite the importance of burnout prevention during plastic surgery residency, less than a quarter of residency program social media content promote wellness. Social media can demonstrate how residency programs are incorporating wellness into their curricula, but whether residencies lack sufficient wellness initiatives or are not advertising such programming on their social media accounts remains to be studied.

Representation of Global Health Initiatives in Plastic Surgery Training: A Social Media Analysis.

INTRODUCTION: Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration. METHODS: A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. A total of 82 programs were identified. Instagram, Facebook, and Twitter were searched for active accounts. Only accounts dedicated to plastic surgery programs or had a significant amount of residency-related content were included. Inclusion criteria included posts relating to global health, global surgery, mission trips, international plastic surgery education, and global surgery research. Caption language was analyzed and classified as either "resident education in global surgery," "an individual's interest in global surgery," "research in global surgery," "visiting international professor," or "global collaboration." Image content was then assessed for "images with patients," "images with other surgeons/residents," "images of international location," a combination thereof, "other," or "none." RESULTS: Instagram was by far the most used by plastic surgery residency programs with a total of 76 programs having accounts compared with only 32 programs and 33 programs having Facebook and Twitter accounts, respectively. There was no significant difference in the proportional number of posts relating to global surgery across the 3 platforms (P = 0.1911). On all 3 social media platforms, the majority of posts fell into the category of "international collaboration" with 42.5%, 50.7%, and 48.8% on Instagram, Facebook, and Twitter, respectively. None of the caption categories examined showed a significantly different proportion of posts across the 3 platforms. Image analysis showed a significant difference in the proportional representation across the 3 platforms in the categories of "images with other surgeons/residents" (P = 0.0196) "images with patients" (P = 0.0082), combination (P = 0.0225), and other (P = 0.0114). CONCLUSIONS: Although social media offers programs an easy way to promote global surgery research, collaboration, and education with a wider audience, it is being underused for this purpose as evident by the relatively lower number of postings on each platform relating to this content.

Are Opioids Out? Assessing Prescription Patterns in Plastic Surgery Using Medicare Part D Beneficiary Data.

INTRODUCTION: Since 1999, nearly 841,000 individuals have died from overdoses, 29% involving prescription opioids. Use of opioids for postoperative pain lacks evidence-based guidelines, and despite studies showing the efficacy of nonopioid agents in reducing postoperative morbidity, opioids are still routinely prescribed. However, multiple states are adopting prescription drug monitoring programs and prescription drug laws. The authors sought to investigate recent opioid prescription patterns among plastic surgeons. METHODS: This cross-sectional study used "Medicare Provider Utilization and Payment Data: Part D Prescriber" provided by the Centers for Medicare & Medicaid Services from 2016 to 2018. Entries were filtered to include plastic surgeons. Demographic variables included surgeon sex, geographic region and state, board certification status, and length of experience. The surgeon's practice was designated as academic, private, or both. Outcomes included total opioid claims, opioid prescriber rate, and days per claim. Kruskal-Wallis tests were used for statistical comparison (α = .05). RESULTS: From 2016 to 2018, plastic surgeons wrote 289,525 opioid prescriptions for 1,729,523 days (6.0 days per prescription), totaling $3,346,979.39. In 2018, 62.2% of plastic surgeons prescribed 0 to 10 opioids, 36.5% prescribed 11 to 50 opioids, and 1.3% prescribed more than 50. Furthermore, 99.5% of plastic surgeons prescribing opioids are practicing in metropolitan areas (rural-urban commuting area codes 1-3). Plastic surgeons who were male or were board certified had significantly lower opioid prescriber rates (P < 0.001). There were no significant variations in outcomes by length of surgeon experience. Geographic region was significantly associated with opioid prescription rates and days per claim, with Southern plastic surgeons having lower rates (P < 0.001) and those Northeastern ones prescribing shorter courses (P = 0.004). The number of opioid claims, days per claim, and opioid prescriber rates were all significantly lower in 2018 than in 2017 and 2016 (P < 0.001). CONCLUSIONS: Prescriptions written by plastic surgeons may have contributed to the opioid epidemic, but 2018 data suggest opioids are becoming less routine in postoperative pain control. Further studies are warranted to assess factors related to reduced and shorter opioid prescriptions by plastic surgeons in the South and Northeast, respectively. Such insight, if adopted into law and implemented into clinical practice, may help reduce the burden of the opioid epidemic.

Diversity in Plastic Surgery: Analysis of Representation of Sex and Ethnic Diversity in Plastic Surgery Residency Social Media Accounts.

BACKGROUND: Increasing health care diversity is critical to overcoming disparities. Plastic surgery has been working to improve diversity through various efforts, including social media movements like Diversify PRS and #ilooklikeasurgeon. Because residency programs' social media sites serve as a public symbol of the programs' values and can attract potential applicants, we sought to analyze such platforms for content highlighting sex and ethnic diversity. METHODS: Integrated plastic surgery residency programs during the 2020 to 2021 academic year were found on the American Council of Academic Plastic Surgeons website, and their associated social media accounts were identified. The authors reviewed each program's account for all posts published by November 8, 2021, for content promoting sex or ethnic diversity. Any hashtags related to diversity were also recorded. Nonparametric Mann-Whitney U and Kruskal-Wallis tests were used to compare percentages of total social media posts related to sex and ethnic diversity between programs (α = 0.05). RESULTS: Of 82 programs, 76 (92.7%) had active Instagram accounts, 29 (35.4%) had active Facebook accounts, and 29 (35.4%) had active Twitter accounts. Across all platforms, 19.0% of all posts were promoting sex diversity and 3.3% were promoting ethnic diversity. Of 4651 posts promoting sex diversity, 4067 (87.4%) highlighted women, 1017 (21.9%) featured all-women teams, 779 (16.7%) used sex diversity-related hashtags, and 300 (6.5%) included purposeful statements. Of 808 posts promoting ethnic diversity, 527 (65.2%) used ethnic diversity-related hashtags, 224 (27.7%) included purposeful statements, 199 (24.6%) mentioned ethnic background, and 36 (4.5%) used different skin-toned emojis. Programs did not vary in percentages of posts related to diversity by geographic region, ranking, accreditation length, or engagement rate. The percentage of posts promoting sex diversity was greater than that promoting ethnic diversity (P < 0.001). The most used diversity hashtag was #ilooklikeasurgeon. CONCLUSIONS: Despite the importance of increasing recruitment of trainees from diverse backgrounds to plastic surgery and the global reach of social media movements like #ilooklikeasurgeon, sex and ethnic diversity are still poorly promoted on residency social media accounts. Increasing such content is a simple yet powerful way to create a culture of inclusivity for all applicants.

Increasing Incidence of Hand and Distal Upper Extremity Injuries Associated With Electric Scooter Use.

PURPOSE: Electric scooters (e-scooters) have seen an increase in popularity in cities across the United States as a form of recreation and transportation. The advent of ride-sharing applications allows anyone with a smartphone to easily access these devices, without any investment or experience required. In this study, the authors analyze scooter-related injuries of the hand and upper extremity. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried to look for injuries related to the use of e-scooters between 2010 and 2019. Data collected included demographic information, the location of the injury, the injury diagnosis, and disposition. National estimates (emergency room visits in the United States) were calculated using the weight variable included in the NEISS database. Miscoded reports were excluded. As a corollary, Google Trends data were utilized to establish a correlation between e-scooter-related injuries and the relative number of e-scooter hits on the Google search engine. RESULTS: From 2010 to 2019, there were 730 e-scooter-related injuries reported to the NEISS database. This corresponds to an estimated 26,412 injuries nationally during this time period. The incidence of scooter-related injuries increased by over 230% (2,130 national injuries in 2010; 7,213 national injuries in 2019; relative difference 5,083). Injuries most commonly occurred in patients aged 10 to 18 years (30.3%). The most frequent site of injury was the wrist (41.9%). The most common injury diagnosis was fracture (55.3%). Additionally, there was a correlation between the number of Google Trends e-scooter hits and the number of injuries during this time period. CONCLUSIONS: The incidence of e-scooter-related upper extremity injuries increased dramatically in the United States between 2010 and 2019. CLINICAL RELEVANCE: As novel e-scooter-sharing apps become increasingly popular, it is imperative that users are educated about the risk of injury and that use of proper protective equipment is encouraged.

How Comprehensive Are Aesthetic Surgery Fellowship Websites?

BACKGROUND: Fellowship programs heavily utilize websites in the recruitment of senior residents. Studies in subspecialty areas have demonstrated deficiencies in website content; however, no study has evaluated the websites of esthetic surgery fellowships. The recent establishment of the aesthetic fellowship match in 2018 highlights the need for accessible program information. OBJECTIVE: To assess the success in accessibility of educational and recruitment content of aesthetic surgery fellowship websites for prospective applicants. METHODS: Websites of aesthetic surgery fellowships were eligible for study inclusion. Aesthetic fellowship websites (AFWs) were evaluated for content regarding fellow education and fellow recruitment. Website content was analyzed using Fisher exact test and analysis of variance. RESULTS: Twenty-eight programs were compiled from the American Society of Aesthetic Plastic Surgery website. Regarding fellowship education, 35.7% of AFWs described operative experience and research requirements, and 28.6% of AFWs included information on didactics, but less than 11% outlined rotation schedules, annual meetings, or academic conferences. None listed fellow evaluation criteria. Regarding recruitment information, 85.7% of AFWs had program descriptions, but less than 33% listed affiliated hospitals, faculty, or current fellows. Of the 67.9% of AFWs that listed eligibility criteria, none listed selection criteria. When programs were stratified by the type of aesthetic training offered, fellowships that offered whole-body aesthetic training had significantly more recruitment content (P = 0.0394) on their websites than those specializing in facial aesthetics only. CONCLUSIONS: There is a paucity of information regarding recruitment and education on AFWs. Programs should strive to create a comprehensive website to better attract and assist residents applying for fellowship.

Analysis of the impact of chronic corticosteroid use on free flap reconstruction.

BACKGROUND: Systemic corticosteroids negatively impact wound healing, potentially increasing postoperative wound complication rates. In this study, the authors utilize the American College of Surgeons (ACS) National Surgical Quality Improvement (NSQIP) database to investigate the impact of chronic steroid usage on postoperative complications following microvascular free tissue transfer procedures. METHODS: The ACS NSQIP database was queried for all free flap procedures performed between 2005 and 2016. Patients with a history of chronic steroid use (n = 159) were compared to patients with no history of chronic steroid use (n = 3,405). The two cohorts were compared by univariate analysis, followed by multivariate binary logistic regression for all complications noted to be statistically significant on univariate analysis. RESULTS: Patients treated with systemic corticosteroids were more likely to be smokers, have a history of diabetes, hypertension, bleeding disorders, hypoalbuminemia, anemia, and have a wound infection at time of surgery. There were increased rates of bleeding requiring transfusion (37.7 vs. 27.5% p = .005), overall surgical complications (48.4 vs. 36.7%, p = .003) and overall complication rates (56.0 vs. 42.3%, p = .001) in these patients. On multivariate analysis, chronic steroid use was not associated with increased risk of surgical complications (OR = 2.540, p = .056, 95% CI 0.975-6.622), overall complications (OR = 2.303, p = .086, 95% CI 0.888-5.973), or wound complications. However, chronic steroid usage conferred nearly a four times increased risk for major bleeding complications (OR = 3.995, p = .009, 95% CI 1.415-11.279). CONCLUSION: Chronic corticosteroid use does not increase rates of wound complications, reoperation, or readmission. However, this population may be at increased risk for major bleeding requiring blood transfusion following free flap reconstruction.

Superficial temporal artery perforator flaps for reconstruction of intraoral defects.

BACKGROUND: Intraoral defects after tumor resection are often reconstructed with free tissue transfer. However, in patients who are not good candidates for free tissue transfer, regional flaps based on the superficial temporal artery can be utilized. The authors present our technique to reconstruct intraoral defects with the superficial temporal artery perforator (STAP) flap and early outcomes. METHODS: Five patients underwent STAP flaps for defects including the hard palate, buccal sulcus, floor of mouth, and retromolar trigone between 2017 and 2019. The mean defect size was 5.6 × 3.4 cm2 (3 × 3 cm2 - 7 × 4 cm2 ). The mean age was 74 (57-88) and all patients had recurrent cancer. External Doppler, indocyanine green laser angiography, and FLIR thermal imaging were used intra-operatively to identify the best perforators and plan for flap design. RESULTS: The mean flap size was 7.6 × 3.5 cm2 (6 × 3 cm2 - 10 × 5 cm2 ). Four flaps were based off of the posterior branch of the STA, while the fifth was based off of the anterior branch. Two donor sites were closed primarily, and three required skin grafts. One patient experienced partial flap necrosis. There were no complete flap losses and no donor site complications. Average follow up was 14.6 months (9-20 months). All patients maintained preoperative level of speech, mastication, and oral continence. CONCLUSIONS: The STAP flap can be based on the anterior or posterior branch of the superficial temporal artery and is a useful regional flap for intraoral defects after tumor resection.

The Cost of the "July Effect" in Microsurgery.

The existence of the "July effect," or the idea that the new academic year intrinsically has an increased complication rate is evaluated in microsurgical free tissue transfer procedures. The National Surgical Quality Improvement Program registry was queried for all free flap procedures performed between 2005 and 2016 (n = 3405). Cases were grouped as having occurred in the first academic quarter (Q1: July 1-September 30) or fourth quarter (Q4: April 1-June 30). Demographical data and complications were compared using univariate χ analysis, multivariate logistic regression was used to control for confounding variables, and inpatient stay and operating cost estimates were created. Of a total of 1722 cases, 905 were performed in the first academic quarter and 817 were performed in the fourth academic quarter. There was no significant difference between Q1 and Q4 in readmission rate (P = 0.378) or reoperation rate (P = 0.730). Patients in Q1 had significantly longer operative times (P = 0.001) and length of stay (P = 0.002) compared with those in Q4. In addition, cost of inpatient stay and operating costs associated with each free flap were significantly increased in Q1 compared with Q4 (P = 0.029; P = 0.001). The total cost per quarter for free flaps was also significantly more expensive in Q1 vs Q4, with the highest average difference in cost of $350,010.64 (P = 0.001). Having surgery early in the academic year does not put patients at any increased risk for major complications but is associated with increased operating time, length of stay, and total cost.

A Multimetric Health Literacy Analysis of Online Information for Gluteal Augmentation With Fat Grafting.

BACKGROUND AND OBJECTIVES: According to the American Society of Plastic Surgeons the number of gluteal augmentations with fat grafting, colloquially known as the "Brazilian buttock lift" (BBL), doubled from 2014 to 2018. Recent studies have demonstrated that gluteal augmentation with fat grafting has a higher mortality rate when compared with other esthetic surgeries. We hypothesize that online patient-directed information for gluteal augmentation are overly complex, written at an elevated reading grade level, with incomplete or no information regarding associated surgical risks. OBJECTIVE: To perform an objective appraisal of the most popular online patient education materials for gluteal augmentation surgery and explore potential interventions for improving material quality. METHODS: An online Google search using the term "Brazilian butt lift" was performed and the top 10 websites providing relevant information were identified. Readability for each website was determined using Readability Studio. Understandability, actionability and cultural sensitivity was assessed with validated tools by 2 independent raters. RESULTS: The top 10 websites were written at a mean reading grade level of 13.0, appropriate for a high school graduate. No website was written at the American Medical Association and the National Institutes of Health recommended 6th to 8th grade reading level. Mean understandability and actionability scores of 51% and 18.9%, respectively, suggest significant room for improvement. The average cultural sensitivity assessment tool score was 2.30, below the recommended threshold for acceptability of 2.5. Ninety percent of all websites did not meet the threshold for cultural acceptability. CONCLUSIONS: Online patient education materials for gluteal augmentation with fat grafting were written at an inappropriately elevated reading grade level and were overly complex, did not promote reader action, and were not sensitive to the needs of the target demographic.

Abstract to Publication in Microsurgery: What Are the Discrepancies?

BACKGROUND: The American Society for Reconstructive Microsurgery (ASRM) annual meeting is a forum to present new research abstracts prior to peer-reviewed publication. The aim of this study is to determine the conversion rate, discrepancies, and time between presentation and publication. METHODS: A comprehensive literature search was conducted cross-referencing ASRM abstracts presented between 2014 and 2018 with peer-reviewed manuscripts. The title and authors of the abstract and manuscript, the journal of manuscript publication, and time in months between presentation and publication were recorded. The conversion rate was calculated as the proportion of publications to abstracts. Major discrepancies were defined as changes in the purpose, study design, methods, sample size, statistical analysis, results, or conclusions. Minor discrepancies were defined as changes in the title or authorship. RESULTS: Out of 667 oral abstract presentations, 361 (54%) resulted in publication. Of these abstracts, 53 were presented after their corresponding manuscripts were published. The mean conversion rate was 55.52 ± 10.17%. The mean time from presentation to publication was 13.83 months. Minor discrepancies were more frequent than major discrepancies (91 vs. 76%). The most common major and minor discrepancies involved changes in the results (63%) and authorship (79%), respectively. There was a significant association between the year of abstract presentation and whether the conclusion was changed (p = 0.001), but interyear relationships with all other discrepancies failed to reach statistical significance. CONCLUSION: Only around half of abstracts presented at the annual ASRM conference have reached full publication in peer-reviewed journals, and most are undergoing significant changes between presentation and publication. This may be due to panel discussions at meetings suggesting study modifications, as well as revisions after careful peer review. Altering surgical practices may not be recommended based on abstracts' content.

Utility of Regional Anesthesia in Extremity Reconstruction.

BACKGROUND: Regional anesthesia (RA) may help to circumvent the well-documented risks associated with general anesthesia, increase patient comfort and satisfaction, and mitigate costs. This study aims to investigate the utility of RA in extremity reconstruction. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all cases of extremity reconstruction including muscle, myocutaneous, or fasciocutaneous flaps from 2005 to 2016. Two groups were created based on anesthesia technique, regional/epidural and general. Postoperative complications included reoperation, readmission, and wound complications. Propensity score matching was utilized to control for variation in sample size, significant comorbidities, and demographics in the analysis of complications. RESULTS: A total of 2,874 cases were identified with general anesthesia utilized in 2,820 cases and RA in the remaining 54. After propensity score matching, 53 cases were identified in each group. In both unmatched and matched cohorts, there was no statistically significant difference in the rates of reoperation, readmission, or wound complication rates. In the matched cohort, mean operative time in the RA cohort was significantly shorter, 157.64 (±112.36) minutes compared with 293.06 minutes (±201.35 minutes) in the general anesthesia group (p < 0.001). While no statistically significant difference was detected in mean length of stay (LOS) between the two groups, the RA group experienced a clinically significant shorter LOS of 5.77 days (±5.87 days) compared with 7.02 (±5.61) days in the general anesthesia group (p = 0.269). CONCLUSION: RA may be a safe, reasonable alternative to general anesthesia in extremity reconstruction without increase in postoperative complications. Additionally, RA use is associated with a significant reduction in operative time, potentially leading to shorter and safer procedures without compromising outcomes.

YouTube for Cosmetic Plastic Surgery: An Effective Patient Resource?

BACKGROUND: YouTube is increasingly being utilized as a major educational resource by patients. It is important for plastic surgeons to understand the quality and characteristics of videos that patients are likely to view about procedures of interest. OBJECTIVES: The aim of this study was to evaluate the quality of the videos that patients are most likely to encounter when searching YouTube for the most common cosmetic plastic surgery procedures. METHODS: Based on Google Trends data, the most searched medical and colloquial terms were identified for common cosmetic surgery procedures: "abdominoplasty," "tummy tuck," "breast augmentation," "boob job," "liposuction," "lipo," "mastopexy," "breast lift," "reduction mammoplasty," and "breast reduction." On YouTube, videos were searched by relevance (default) and view count; the top 10 results were collected in each group and rated according to the DISCERN criteria. Each video was assigned an overall and bias DISCERN score (DS). A score of 1 indicates high bias and low overall quality and a score of 5 indicates the opposite. RESULTS: In total, 143 unique videos were identified, which resulted in a mean bias DS of 2.29 and mean overall DS of 2.44. Seventy-two videos included US board-certified plastic surgeons and 58 were classified as patient experience. Videos had 667,373,209 total views and were an average of 4.27 years old. Videos including US board-certified plastic surgeons were of significantly higher quality and showed lower bias than videos without these practitioners (P < 0.05). CONCLUSIONS: Overall, YouTube videos showed high bias and low quality. Plastic surgeons should be aware of this popular resource and counsel patients about the bias that is often present. Plastic surgeons and academic plastic surgery organizations should strive to upload high-quality, unbiased videos to provide patients with a more appropriate resource.

A Three-Step Technique for Optimal Nipple Position in Transgender Chest Masculinization.

BACKGROUND: The ideal position of the nipple-areola complex (NAC) in the transgender population can be a challenge to determine. OBJECTIVES: The authors sought to determine the best location and aesthetics of the female to male NAC. METHODS: Patients who underwent female to male mastectomy with free nipple grafting were included. NAC position is confirmed utilizing a vertical coordinate at the level of the 4th rib near the border of the pectoralis muscle and a horizontal coordinate determined by dividing each unilateral chest into vertical thirds from midline to anterior axillary line laterally. The NAC position is confirmed at the junction of the middle and lateral third. Symmetry is ensured bilaterally by creating a triangle and transposing it side to side; the base lies from sternal notch to inframammary fold in the midline and the apex is adjusted to the NAC. A 24-question survey utilizing a 5-point Likert scale was distributed postoperatively to assess the patient's thoughts about their chest, nipples, scar, and overall experience with the gender affirmation process. RESULTS: Thirty-one patients were included in this study. Eighteen patients responded to the postmastectomy survey, all of whom were highly satisfied with the aesthetic result postoperatively. All patients felt comfortable with their exposed chest. Nipple location was particularly highly received with 100% satisfaction rate (mean Likert score, 4.72). Nipple size and shape received a mean Likert score of 4.17 and 3.89, respectively. CONCLUSIONS: The triple confirmation technique is an easy, reproducible method to guide the surgeon in relocation of the NAC.

Outcomes in Chest Wall Reconstruction Using Methyl Methacrylate Prostheses: A Review of the Literature and Case Series Utilizing a Novel Approach with Biologic Mesh.

BACKGROUND: Composite defects after chest wall resection may leave patients at risk with lack of protection of vital structures and potentially respiratory compromise secondary to flail segments. Reconstruction of the chest wall with various alloplastic materials is possible and well described. Here, the authors present a novel technique in chest wall reconstruction utilizing a methyl methacrylate (MMA) "sandwich" with biologic mesh. The authors also sought to determine outcomes in chest wall reconstruction with MMA to optimize surgical decision making and minimize patient morbidity. METHODS: A literature review was conducted using MEDLINE and the Cochrane Collaboration Library for primary research articles on chest wall reconstruction using MMA. Data related to surgical techniques and patient outcomes were extracted and analyzed. The authors also present their case series and outcomes utilizing a novel technique with biologic mesh. RESULTS: Seventy-four articles met inclusion criteria, which included a total of 562 patients. Reconstruction methods included three main variations of the MMA prosthesis and six institution-specific variations. Complications were reported in 13.7% of patients; the most common complications included infection (5.6%), respiratory failure (3.3%), and atelectasis (1.7%). Less commonly reported complications included prosthesis dislocation (1.2%), pneumonia (1.0%), and lung collapse (0.4%). Overall mortality due to respiratory causes was observed in nine patients (1.6%). In our case series, complications included respiratory failure and seroma was reported in one patient, with no complications at long-term follow-up. CONCLUSION: There are a variety of options available for rigid and nonrigid prosthetic repair of the chest wall. We present the first successful reported case series of reconstruction using biologic mesh as a component of the MMA sandwich prosthesis. MMA appears to be a safe and effective choice for rigid reconstruction when used alone or in conjunction with synthetic or biologic mesh.

New Kid on the Block: A Systematic Review of the Quadratus Lumborum Block in Plastic and Reconstructive Surgery.

Background: Although the transversus abdominal plane (TAP) block is commonly used in abdominal surgery as part of enhanced recovery after surgery pathways, the quadratus lumborum (QL) block has been hypothesized as an effective alternative to the TAP block in some areas. This review evaluates the current literature, as it relates to the QL block in plastic and reconstructive surgery. Methods: A systematic review using PubMed searched for all original, peer-reviewed articles, including the term "quadratus lumborum block." In total, 509 articles were identified for review by two independent reviewers. Original articles evaluating the use of a QL block in any plastic surgery operation were included. Articles evaluating pediatric patients, animal trials, and the use of a QL block in any nonplastic surgery operation were excluded. Results: Three articles met inclusion criteria. One trial demonstrated decreased subjective pain scores and total opioid use, whereas the second found no statistically significant difference. A case study described the use of a QL block for unilateral breast reconstruction with minimal opiate use and reduced pain scores postoperatively. Limitations include the limited number of studies and the heterogeneity in study type and design, making analysis difficult. Conclusions: Despite its demonstrated efficacy in other surgical subspecialties, there are limited data evaluating the use of the QL block in plastic and reconstructive surgery. Additional research is needed to evaluate the role of the QL block in plastic surgery and how it compares to the more widely utilized TAP block.