Search

Background:. The insertion of a mesh “internal bra” has been used in cosmetic breast procedures for soft-tissue reinforcement as a means to mitigate postoperative ptosis. However, there have been concerns regarding complications as a result of mesh placement and a lack of quantitative data regarding postoperative cosmetic outcomes. Methods:. Articles that assessed the effects of the mesh internal bra for soft-tissue support on cosmetic and patient-reported outcomes, complications, and surveillance were reviewed. Meta-analysis was performed to determine the overall complication rates, and cosmetic outcomes and patient-reported outcomes were reviewed. Results:. Meta-analysis showed the following summary effect sizes: infection/abscess had a pooled rate of 3.61% (Q = 33.8, I2 = 76.33%), hematoma was 1.34% (Q = 4.16, I2 = 68.1%), seroma was 5.04% (Q = 14.8, I2 = 73.11%), fat necrosis was 0.86% (Q = 693, I2 = 99.7%), and capsular contracture was 2.5% (Q = 693.4, I2 = 99.6%). Only 2 of 5 studies attempting to quantify cosmetic outcomes compared outcomes between patients who underwent procedures with and without the use of mesh. Both reported smaller increases in sternal notch-to-nipple distance and nipple-to-inframammary fold distance without clear statistical significance. Conclusions:. Although there does not seem to be a significant difference in risk profile with and without the use of mesh, the current data do not support the claims of improved cosmetic outcomes. Well-controlled, quantitative studies are necessary to objectively evaluate the cosmetic benefits of using mesh.

Background:. Postoperative dressings expedite wound healing and decrease the rate of infection. Options for wound dressings vary based on cost, time to apply, method of wound healing, and availability at the hospital; however, a significant difference in postoperative complications between each type has not been found. As such, this study evaluates patient cosmetic preferences for various wound dressings as it relates to early postoperative satisfaction. Methods:. A cross-sectional study was conducted using an online crowdsourcing service that connects research studies to participants. The survey asked users to rate images of various wound dressings. Steri-Strips, Dermabond PRINEO (Johnson & Johnson, Ethicon, Inc.), gauze, surgical tape, and metal staples were the materials assessed. The ratings, based on cleanliness, compactness, and aesthetics, culminated in an average cosmetic score for each dressing. Results:. Controlled for demographics, Steri-Strips and staples were the highest rated dressing types by participants and may correlate with increased patient satisfaction in the immediate postoperative period. Gauze was highly rated for aesthetics and cleanliness but averaged lower scores due to dressing bulk. Dermabond and surgical tape had the lowest and second lowest cosmetic score, respectively. Conclusions:. Although cost, availability, and time to apply are common factors surgeons evaluate when picking a dressing, cosmetic preference is another consideration. Allowing the patient to participate in dressing selection may give them more perceived autonomy and increase immediate postoperative satisfaction. Limitations of this study include limited lighting/positioning standardization of dressing photographs. This analysis does not consider opinions on later wound healing or scarring using the chosen material.

Summary:. As we enter a new year, this article serves as an opportunity to ponder on the impact of a worldwide pandemic on physicians and the field of plastic surgery, which began 4 years ago in January 2020. When looking at the data in the general-surgery and reconstructive literature, the surgical treatment of patients with COVID-19 appears safest 8 weeks after infection. It was also found that the so-called Zoom-boom crush of cosmetic surgery cases following pandemic lockdown appeared to be largely due to a backlog of cases. Cosmetic surgery, particularly facial cosmetic surgery, continues to increase in popularity year over year. However, the effects on plastic surgery training remain unclear. Even so, those affected by the pandemic seem more driven than ever to find job stability and security.

Background:. Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients. Methods:. A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates. Results:. Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies. Conclusions:. Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.