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Background: Multiple skin-sparing incisions are utilized in immediate post-mastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large ptotic breasts compared to non-Wise pattern incisions (NWPI). We evaluated patient demographics and surgical outcomes with WPI versus NWPI., Methods: An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with ICD-10-CM diagnosis code "Z42.1: encounter for breast reconstruction following mastectomy." Retrospective chart review evaluated patient demographics, intraoperative factors, postoperative complications, and surgical cost., Results: 288 patients were included; 58 had WPI and 230 had NWPI. Median BMI differed between WPI (30.5) and NWPI (26.4) (P < 0.001). 57% of WPI had preoperative grade 3 ptosis versus 23% of NWPI (P < 0.001). No difference was found in median operative times (WPI: 219 minutes, NWPI: 194 minutes, P = 0.38). Overall rates of postoperative complications differed between WPI (62%) and NWPI (45%) on univariate, but not multivariate, analysis. Median total surgery charge was higher for WPI (WPI: $36,223, NWPI: $31,185, P < 0.001), while implant cost was higher for NWPI (WPI: $2,700, NPWI: $8,040, P < 0.001)., Conclusions: There was no significant difference in operative time, overall complication rate, or charge between incision types once adjusted for confounding factors. The higher complication rate in the WPI group was likely driven by higher BMI, a known risk factor for surgical complications regardless of approach. Surgeons can consider WPI as a noninferior option for patients with higher BMI and ptosis., Competing Interests: Financial Disclosure Statement: The authors have no conflicts of interest to declare., (Copyright © 2024 by the American Society of Plastic Surgeons.)

While there is emerging evidence of sex differences in decision-making behavior, the neural substrates that underlie such differences remain largely unknown. Here we demonstrate that in mice performing a value-based decision-making task, while choices are similar between the sexes, motivation to engage in the task is modulated by action value more strongly in females than in males. Inhibition of activity in anterior cingulate cortex (ACC) neurons that project to the dorsomedial striatum (DMS) preferentially disrupts this relationship between value and motivation in females, without affecting choice in either sex. In line with these effects, in females compared to males, ACC-DMS neurons have stronger representations of negative outcomes and more neurons are active when the value of the chosen option is low. By contrast, the representation of each choice is similar between the sexes. Thus, we identify a neural substrate that contributes to sex-specific modulation of motivation by value., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

How are actions linked with subsequent outcomes to guide choices? The nucleus accumbens, which is implicated in this process, receives glutamatergic inputs from the prelimbic cortex and midline regions of the thalamus. However, little is known about whether and how representations differ across these input pathways. By comparing these inputs during a reinforcement learning task in mice, we discovered that prelimbic cortical inputs preferentially represent actions and choices, whereas midline thalamic inputs preferentially represent cues. Choice-selective activity in the prelimbic cortical inputs is organized in sequences that persist beyond the outcome. Through computational modeling, we demonstrate that these sequences can support the neural implementation of reinforcement-learning algorithms, in both a circuit model based on synaptic plasticity and one based on neural dynamics. Finally, we test and confirm a prediction of our circuit models by direct manipulation of nucleus accumbens input neurons., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)