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Background:. Scarring negatively impacts patient mental health, causing worsened self-confidence, body image, and social interactions, as well as anxiety and depression. The objective of this study is to evaluate the scarring impact after facial surgery, breast surgery, and full abdominoplasty for symptoms, appearance, psychosocial health, career, and sexual well-being using validated patient-reported outcome measures. Method:. A total of 901 patients from five providers completed the SCAR-Q (covering symptoms, appearance, and psychosocial) and Career/Sexual Well-being assessments via phone or email where a higher score indicated a more positive scar perception. Results:. Of the 901 patients, 38.1% had abdominoplasty surgery, 38.1% breast reduction, 15.3% facial surgery, 4.7% breast lift, and 3.9% breast augmentation. The differences in SCAR-Q, appearance, and symptom scores between the five procedures were statistically significant. Breast augmentation SCAR-Q scores (median = 256) and facial surgery (median = 242) were significantly higher than those of abdominoplasty patients (median = 219; P = 0.003 and P = 0.001, respectively). Duration after surgery was positively correlated with improved symptom scale scores for abdominoplasty (r = 0.24, P < 0.001), breast augmentation (r = 0.71, P = 0.015), and facial surgery patients (r = 0.28, P = 0.001), but not for other procedures. Conclusions:. This study is the first to show that breast augmentation and facial surgery patients have a more positive perception of their scars in terms of appearance, symptoms, psychosocial, career, and sexual well-being impact than abdominoplasty patients. Furthermore, the data suggest that symptoms may improve over time for abdominoplasty, breast augmentation, and facial surgery patients. This study highlights the need for further follow-up, counseling, or other improvements to postoperative scar care.

Background:. Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and risk factors for implant malposition in this setting. Methods:. Retrospective review of a single surgeon’s prosthetic breast reconstructions was performed. Variables collected included age, BMI, radiation, chemotherapy, implant characteristics and malposition location (inferior or lateral). Binary logistic regression identified risk factors for malposition. Chi-square test assessed malposition rate as a function of implant volume to BMI subgroups. Results:. Of 836 breasts, 82 (9.8%) exhibited implant malposition. Risk factors for any malposition were older age (OR 1.05, 95% CI 1.02-1.07), BMI

Background:. Despite growing use of surgical risk calculators, many are limited to 30-day outcomes due to the constraints of their underlying datasets. Because complications of breast reconstruction can occur well beyond 30 days after surgery, we endeavored to expand the Breast Reconstruction Risk Assessment (BRA) Score to prediction of 1-year complications after primary prosthetic breast reconstruction. Methods:. We examined our prospective intrainstitutional database of prosthetic breast reconstructions from 2004 to 2015. Patients without 1-year follow-up were excluded. Pertinent patient variables include those enumerated in past iterations of the BRA Score. Outcomes of interest include seroma, surgical site infection (SSI), implant exposure, and explantation occurring within 1 year of tissue expander placement. Risk calculators were developed for each outcome using multivariate logistic regression models and made available online at www.BRAScore.org. Internal validity was assessed using C-statistic, Hosmer-Lemeshow test, and Brier score. Results:. Nine-hundred three patients met inclusion criteria. Within 1-year, 3.0% of patients experienced seroma, 6.9% infection, 7.1% implant exposure, and 13.2% explantation. Thirty-day, 90-day, and 180-day windows captured 17.6%, 39.5%, and 59.7% of explantations, respectively. One-year risk calculators were developed for each complication of interest, and all demonstrated good internal validity: C-statistics for the 5 models ranged from 0.674 to 0.739, Hosmer-Lemeshow tests were uniformly nonsignificant, and Brier scores ranged from 0.027 to 0.154. Conclusions:. Clinically significant complications of prosthetic breast reconstruction usually occur beyond the 30-day window following tissue expander placement. To better reflect long-term patient experiences, the BRA Score was enhanced with individualized risk models that predicted 1-year complications after prosthetic reconstruction (BRA Score XL). All models performed as well as, if not better than, the original BRA Score models and other popular risk calculators such as the CHA2DS2VASc Score. The patient-friendly BRA Score XL risk calculator is available at www.brascore.org to facilitate operative decision-making and heighten the informed consent process for patients.

Background: Although recent literature suggests that patients with Medicaid and Medicare are more likely than those with private insurance to experience complications following a variety of procedures, there has been limited evaluation of insurance-based disparities in reconstructive surgery outcomes. Using a large, multi-institutional database, we sought to evaluate the potential impact of insurance status on complications following breast reconstruction. Methods: We identified all breast reconstructive cases in the 2008 to 2011 Tracking Operations and Outcomes for Plastic Surgeons clinical registry. Propensity scores were calculated for each case, and insurance cohorts were matched with regard to demographic and clinical characteristics. Outcomes of interest included 15 medical and 13 surgical complications. Results: Propensity-score matching yielded 493 matched patients for evaluation of Medicaid and 670 matched patients for evaluation of Medicare. Overall complication rates did not significantly differ between patients with Medicaid or Medicare and those with private insurance (P = 0.167 and P = 0.861, respectively). Risk-adjusted multivariate regressions corroborated this finding, demonstrating that Medicaid and Medicare insurance status does not independently predict surgical site infection, seroma, hematoma, explantation, or wound dehiscence (all P > 0.05). Medicaid insurance status significantly predicted flap failure (odds ratio = 3.315, P = 0.027). Conclusions: This study is the first to investigate the differential effects of payer status on outcomes following breast reconstruction. Our results suggest that Medicaid and Medicare insurance status does not independently predict increased overall complication rates following breast reconstruction. This finding underscores the commitment of the plastic surgery community to providing consistent care for patients, irrespective of insurance status.

Introduction: Relative value units (RVUs) were developed as a quantifier of requisite training, knowledge, and technical expertise for performing various procedures. In select procedures, increasing RVUs have been shown to substitute well for increasing surgical complexity and have been linked to greater risk of complications. The relationship of RVU to outcomes has yet to be examined in the plastic surgery population. Methods: This study analyzed nearly 15,000 patients from a standardized, multicenter database to better define the link between RVUs and outcomes in this surgical population. The American College of Surgeons' National Surgical Quality Improvement Program was retrospectively reviewed from 2006 to 2010. Results: A total of 14,936 patients undergoing primary procedures of plastic surgery were identified. Independent risk factors for complications were analyzed using multivariable logistic regression. A unit increase in RVUs was associated with a 1.7% increase in the odds of overall complications and 1.0% increase in the odds of surgical site complications but did not predict mortality or reoperation. A unit increase in RVUs was also associated with a prolongation of operative time by 0.41 minutes, but RVUs only accounted for 15.6% of variability in operative times. Conclusions: In the plastic surgery population, increasing RVUs correlates with increased risks of overall complications and surgical site complications. While increasing RVUs may independently prolong operative times, they only accounted for 15.6% of observed variance, indicating that other factors are clearly involved. These findings must be weighed against the benefits of performing more complex surgeries, including time and cost savings, and considered in each patient's risk-benefit analysis. [ABSTRACT FROM AUTHOR]