BACKGROUND: The anterolateral thigh flap (ALTF) has been widely utilized clinically as one of the primary reconstruction methods for maxillary defects. However, there remains a paucity of research on postoperative facial...BACKGROUND: The anterolateral thigh flap (ALTF) has been widely utilized clinically as one of the primary reconstruction methods for maxillary defects. However, there remains a paucity of research on postoperative facial soft tissue symmetry following maxillary defect reconstruction using the ALTF. MATERIALS AND METHODS: Fifty-nine patients who underwent maxillary resection and subsequent reconstruction with ALTF were included in this study. 3D stereophotogrammetry was employed to capture facial morphological data. Facial symmetry was quantitatively evaluated using a landmark-independent method, with qualitative assessment performed using Likert scale. RESULT: The magnitude of the maxillary defect significantly influenced facial asymmetry perception (P < 0.05). Substantial statistical variations (P < 0.05) in the asymmetry of the suborbital, superiolabial, and zygomatic areas across the different classes of maxillary defect were noted. ALTF reconstruction notably reduced lateral discrepancies in suborbital and buccal areas for Class IIId defects (P < 0.05). Flap folding technique showed no significant impact on symmetry across defect classifications. Postoperative removable partial dentures (RPD) significantly improved symmetry in zygomatic, buccal, nasal, and superiolabial areas (P < 0.05). CONCLUSION: Residual facial asymmetry persists following ALTF maxillary reconstruction. While ALTF demonstrates limited efficacy for small defects, it moderately improves facial symmetry in extensive defects. Small defects require thinning the ALTF to improve contour and extensive defects require supplemental hard tissue support in suborbital, zygomatic, buccal, and superiolabial areas. Flap folding did not show significant symmetry improvement, and RPD provide effective hard tissue support, mitigating soft tissue collapse-related deformities, which serving as exploratory observations warranting further investigation.
BACKGROUND: The superomedial pedicle (SMP) is favored for preserving nipple-areolar complex (NAC) vascularity and superior pole fullness. However, its use in breast reductions (BR) with sternal notch-to-nipple (SN-N) dis...BACKGROUND: The superomedial pedicle (SMP) is favored for preserving nipple-areolar complex (NAC) vascularity and superior pole fullness. However, its use in breast reductions (BR) with sternal notch-to-nipple (SN-N) distances ≥40 cm is debated. This study evaluates the safety and efficacy of SMP in such cases. METHODS: A retrospective review was performed on patients who underwent SMP-based BRs from March 2022 to February 2025. Inclusion criteria included age ≥18, SN-N ≥40 cm, and ≥1 month follow-up. RESULTS: 54 breasts (29 patients) were included. Median resection weight was 1,237.5 g per breast (range: 750-2,600 g). Median SN-N distance was 42.0 cm (range: 40.0-48.0 cm). Five (9.3%) breasts experienced at least one complication: hematoma (n=1), minor dehiscence (n=1), fat necrosis (n=1), and minor skin necrosis (<2 cm; n=3). No reoperations occurred. Breasts were stratified by a 1,240 g resection cutoff. Patients in the >1,240 g group had higher BMI (40.7±5.4 vs. 37.6±5.3; p=0.041). On multivariable logistic regression, adjusted for BMI, N-IMF, SN-N, and resection weight, there were no statistically significant associations with complications (all p≥0.05). Propensity score matching revealed, which included BMI, N-IMF, and SN-N, complication rates were comparable between >1,240 g (n=27 breasts) and ≤1,240 g (n=12 breasts) groups (average treatment effect on the treated=0.111; p=0.829). CONCLUSION: SMP is safe in patients with SN-N ≥40 cm and large resection weights. These findings challenge the notion that SMP is contraindicated for SN-N >35 cm and suggest that, with technique modifications, it can be safely used in longer SN-N distances without increased complications.
Postoperative pain management at the rib cartilage harvest site for total microtia construction remains a challenge for many patients, leading to prolonged hospital stays and increased use of post-operative analgesics. C...Postoperative pain management at the rib cartilage harvest site for total microtia construction remains a challenge for many patients, leading to prolonged hospital stays and increased use of post-operative analgesics. Cryoablation of intercostal nerves has been an effective modality of post-operative pain control during pectus excavatum repair, reducing postoperative opioid requirements and decreasing length of hospital stay, without significantly increasing intraoperative time. This technique involves axonotmesis of the intercostal nerves, causing reversible injury with sensory return in approximately 6 months. Given its benefits in pectus excavatum repair, we explored this method of pain control via a percutaneous approach during rib cartilage harvesting for microtia construction. Our experience suggests that this novel application can provide early and sustained analgesia with minimal rib donor site pain as early as postoperative day (POD) 1, without adverse reactions.
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for type 2 diabetes mellitus (T2DM). GLP-1 RA therapy has been linked to facial soft-tissue changes, potentially increasing demand for cor...BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for type 2 diabetes mellitus (T2DM). GLP-1 RA therapy has been linked to facial soft-tissue changes, potentially increasing demand for corrective or aesthetic procedures. This study aims to evaluate whether treatment with GLP-1 RAs in patients with T2DM is associated with an increased long-term incidence of facial and oculoplastic procedures. METHODS: We conducted a retrospective cohort study using the TriNetX database. Adults aged 50-60 years with T2DM were included and divided into GLP-1 RA users and non-GLP-1 users. The occurrence of oculoplastic and facial procedures was assessed over a 10-year follow-up period. Propensity score matching was applied to balance baseline characteristics. Survival analyses were performed using Kaplan-Meier curves and hazard ratios (HRs) were estimated using Cox proportional hazards models. Positive (3P-MACE) and negative (clavicle fracture, rheumatoid arthritis) controls were included. RESULTS: After matching, 297,210 patients remained in each cohort. Over a 10-year follow-up, GLP-1 RA therapy was associated with higher event rates for multiple procedures: upper eyelid blepharoplasty (HR=1.81; p<0.0001), blepharoptosis repair (HR=1.84; p<0.0001), brow ptosis repair (HR=1.87; p=0.0001), lower eyelid blepharoplasty (HR=1.78; p=0.0264), ectropion repair (HR=1.48; p=0.0153), and rhinoplasty (HR=1.96; p=0.012). Entropion repair did not differ significantly (HR=1.25; p=0.387). Positive and negative controls behaved as expected, supporting the robustness of the study design. CONCLUSIONS: GLP-1 RA therapy was associated with an increased long-term incidence of facial and oculoplastic procedures among T2DM patients. Clinicians and surgeons should recognize these effects when counseling patients and planning treatment.
BACKGROUND: Access to gender-affirming surgery (GAS) is contingent on availability of procedures, affordability, legality, and social norms. Regions with higher accessibility to GAS, typically high-income countries, may...BACKGROUND: Access to gender-affirming surgery (GAS) is contingent on availability of procedures, affordability, legality, and social norms. Regions with higher accessibility to GAS, typically high-income countries, may report more surgical and patient-reported outcomes (PROs) data related to GAS, while limited research has characterized outcomes in low- or middle-income countries (LMICs). This meta-analysis characterizes and synthesizes the peer-reviewed literature on GAS-related outcomes in LMICs. METHODS: Electronic databases (MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO) were searched from inception to October 2023. Peer-reviewed articles or conference abstracts that were published in any language, reported GAS surgical or patient-reported outcomes (PROs), and were conducted in LMICs were included and reviewed in duplicate. Pooled proportions (pooled%), 95% confidence intervals (95%CI) and heterogeneity (I 2) were calculated using a random intercept logistic regression model. RESULTS: 150 studies were included (65.3% peer-reviewed articles and 32.7% conference abstracts) from 17 LMICs. Most studies were in English (94.7%) and nearly half were produced by authors from Serbia (30.7%) and Brazil (17.3%), both upper middle-income countries with specialized GAS centers. Vaginoplasty (33.3%), phalloplasty (20.0%), and metoidioplasty (13.3%) were the most reported procedures. Common complications included vaginal stricture/stenosis (pooled%=7.4%, 95%CI=4.1%-12.4%, I 2=85.7%), vaginal fistula (pooled%=2.9%, 95%CI=1.8%-4.4%, I 2=29.6%), phalloplasty urethral stricture (pooled%=14.0%, 95%CI=8.2-22.7%, I 2=87.3%), and phalloplasty fistula (pooled%=16.2%, 95%CI=11.5%-22.3%, I 2=87.7%). Overall complication rates ranged from 0%-73.3%. Most studies reported PROs (65.3%) and 35 studies used validated PRO measures. CONCLUSION: GAS outcome data were lacking from the majority of LMICs, and substantial heterogeneity in surgical complication rates and outcomes measured were noted.
Median nerve (MN) reinnervation in total brachial plexus injury (TBPI) is often neglected due to inconsistent outcomes with sural grafting or use of extra-plexus donors for nerve transfer. 1 Here we describe the novel us...Median nerve (MN) reinnervation in total brachial plexus injury (TBPI) is often neglected due to inconsistent outcomes with sural grafting or use of extra-plexus donors for nerve transfer. 1 Here we describe the novel use of the vascularized nerve flap concept to improve grafting from the C5 root to the MN, using the Free Ulnar Nerve (FUN) flap to improve reliability of perfusion along the entire nerve length. Targeting the MN allows movement of the finger flexors, wrist flexors, and forearm pronators and provides sensation in the hand. Magnetic Resonance Neurography of C5 ventral and dorsal rootlets enables preoperative assessment of C5 spinal nerve stump quality to improve donor reliability. Click or tap here to enter text.2 In 13 consecutive patients with long-term follow-up, ten (77%) regained finger flexion ≥ MRC M2 after median nerve reinnervation. Three achieved ≥ M3 with nerve reconstruction alone, six required tendon transfer from the reinnervated wrist flexors to achieve ≥ M3 and one required additional functioning muscle transplantation reusing the motor branches of the reinnervated median nerve. In 12 patients, the FUN flap simultaneously innervated the musculocutaneous nerve via the dorsal cutaneous branch of the ulnar nerve. Ten patients (83%) achieved ≥ M3 elbow flexion, and 7 (58%) achieved M4 flexion. Twelve patients (92%) regained ≥ S2 sensory function in the palm and thumb. Patients reported meaningful limb use, including eating, carrying objects, and performing daily tasks.
INTRODUCTION: Medicare reimbursement rates for plastic surgery have been consistently falling. Our study is the first to analyze reimbursement by case volume of all procedure codes billed to Medicare by plastic and recon...INTRODUCTION: Medicare reimbursement rates for plastic surgery have been consistently falling. Our study is the first to analyze reimbursement by case volume of all procedure codes billed to Medicare by plastic and reconstructive surgeons from 2013 to 2022. METHODS: All procedure codes billed to Medicare Part B by plastic and reconstructive surgeons were extracted from the CMS Physician and Other Practitioners database. Reimbursements were determined through the Medicare Physician Fee Schedule. Dollar amounts were inflation-adjusted to 2022. RESULTS: 254 procedure codes were included for analysis. From 2013 to 2022, the mean Medicare reimbursement rate for plastic surgery procedures decreased by 22.2% from $337.01 in 2013 to $262.07 in 2022. This results in an average decrease of $7.16 annually (p<0.001). The largest average decreases in reimbursement were observed in musculoskeletal procedures (37.3%, $240.17 to $150.56) and flaps and grafts (31.7%, $617.14 to $421.50). The smallest average decreases in reimbursement were for nervous system (9.6%, $419.99 to $379.65) and hand and upper extremity procedures (14.3%, $610.64 to $523.61). Reimbursement for head and neck procedures decreased by 24.1% from $793.37 to $601.89. Reimbursement for breast procedures decreased by 19.5% from $1216.81 to $979.64. None of the procedure types in our study had an average increase in reimbursement. There was no correlation between changes in volume and reimbursement (R=0.01; p=0.848). CONCLUSIONS: Medicare reimbursement for plastic surgery is consistently decreasing regardless of case volume. The continued decline in reimbursement for plastic surgeons can have negative implications for practice management and access to care.
BACKGROUND: Facial feminization surgery (FFS) is an important aspect of gender affirming care and improves quality of life. However, FFS is sparsely covered by insurance and is the most commonly denied gender affirming p...BACKGROUND: Facial feminization surgery (FFS) is an important aspect of gender affirming care and improves quality of life. However, FFS is sparsely covered by insurance and is the most commonly denied gender affirming procedure. We conducted, to our knowledge, the first cost-effectiveness and budget impact analysis of undergoing FFS. METHODS: We designed a Markov cohort model of 30-year-old transgender women to evaluate the cost effectiveness of FFS compared to no FFS, with 5- and 10-year time-horizons from a U.S. health system perspective, across all accepted willingness-to-pay thresholds (WTPs) in the U.S. ($50,000-$150,000/quality-adjusted life-years [QALYs]). The primary outcomes were the incremental cost-effectiveness ratio in U.S. Dollars (USD) per QALY and the per-member-per-month (PMPM) cost of covering FFS. Transition probabilities and utilities were population-specific and were sourced from published data. Our budget impact model considers projected trends in demand for FFS. RESULTS: Compared to not receiving the surgery, FFS accrued $23,200 more dollars and 0.5 more QALYs across five years, with an ICER of $44,300 [95% CI: $32,200- $63,800]. FFS remained cost effective across all scenarios and sensitivity analyses, notably even with a diminishing mental health benefit of FFS across 10 years. FFS was favored in 100% of 10,000 probabilistic iterations at a WTP of $100,000/QALY. The budget impact of FFS was $0.049 in 2025 and is projected to decrease over the next five years despite a projected increase in demand for FFS. CONCLUSIONS: Insurance coverage of FFS is cost-effective at a WTP of $100,000/QALY with a low budget impact.
Facelift procedures have undergone rapid evolution in the last century, with initially subcutaneous techniques now shifting to superficial musculoaponeurotic system (SMAS) manipulation and deep plane techniques, along wi...Facelift procedures have undergone rapid evolution in the last century, with initially subcutaneous techniques now shifting to superficial musculoaponeurotic system (SMAS) manipulation and deep plane techniques, along with the popularization of concurrent volumization with fat grafting. As surgical technique in facial rejuvenation continues to evolve and long-term outcomes become better understood, experienced facelift surgeons have refined their approaches to enhance aesthetic results and improve patient safety. At the American Society of Plastic Surgeons Spring Meeting in March 2025, four leading expert facelift surgeons spoke on a panel titled, "Facelift - Looking Back: What I Do Now and What I Have Eliminated From My Facelifts," offering insights into their current practices and procedures they have chosen to no longer perform as well as their surgical philosophies. Topics discussed included the contemporary understanding of facial aging and changes, varied approaches to manipulation of the SMAS, innovations in SMAS-based techniques, and drawbacks and complications of both facial and neck rejuvenation. Drawing on 171 years of cumulative experience after training, the panelists presented a critical review of established and emerging practices, emphasizing the importance of surgical customization, critical self-assessment, and surgical technique. Their collective perspectives offer a modern, patient-centered perspective in facial rejuvenation, providing valuable guidance for plastic surgeons.
This article discusses the limitations of current plastic surgery outreach initiatives in low- and middle-income countries (LMICs), which primarily focus on restoring function and often omit restoration of natural form t...This article discusses the limitations of current plastic surgery outreach initiatives in low- and middle-income countries (LMICs), which primarily focus on restoring function and often omit restoration of natural form through aesthetic refinement. Although reconstructive procedures can correct functional impairments, the absence of aesthetic improvements, such as scar revision, symmetry adjustments, and contour corrections, may leave patients facing persistent psychosocial and cultural disadvantages. Research shows that residual deformities can negatively influence perceptions of employability, trustworthiness, and social acceptance, while poor postoperative body image is associated with depression and psychological distress. Existing outreach programs largely operate through vertical models, involving short-term surgical missions, or diagonal models that emphasize capacity building and local training, however neither prioritize aesthetic outcomes. This article proposes a hybrid functional-aesthetic model that integrates aesthetic finishing techniques, structured postoperative follow-up, and training of local surgeons in LMICs. By redefining surgical success to include both functional and aesthetic outcomes, this approach aims to move beyond functional survival and promote more equitable, patient-centered reconstructive care in LMICs.
BACKGROUND: Reduction mammaplasty alleviates the physical and psychosocial burden of macromastia. Elevated body mass index (BMI) is often cited as a risk factor for postoperative morbidity, yet its independent effect rem...BACKGROUND: Reduction mammaplasty alleviates the physical and psychosocial burden of macromastia. Elevated body mass index (BMI) is often cited as a risk factor for postoperative morbidity, yet its independent effect remains unclear. METHODS: A retrospective review of 952 patients (1,904 breasts) undergoing bilateral reduction mammaplasty by a single surgeon (2002-2024) was performed. Patients were stratified into World Health Organization BMI categories. Outcomes of interest included minor (not requiring readmission or reoperation) or major (requiring readmission or reoperation) complications. Logistic regression analyses were conducted, adjusting for diabetes, hypertension, smoking (active or prior), and prior radiation. RESULTS: The mean BMI was 34.0 (17.85-72.6). Overall, 278 (29.2%) patients experienced complications: 153 minor and 125 major. Minor complications increased stepwise with BMI (normal weight 4.7% vs obesity class III 31.2%, p<0.001). On multivariable analysis, obesity class II (OR 2.67, 95% CI 1.19-6.82) and class III (OR 3.40, 95% CI 1.50-8.80) independently predicted minor complications. BMI was not independently associated with major complications. Instead, hypertension (OR 1.70, 95% CI 0.99-2.86, p=0.05), active smoking (OR 2.13, 95% CI 1.08-3.98, p=0.02), and prior smoking (OR 2.94, 95% CI 1.04-7.27, p=0.03) predicted major complications. CONCLUSION: BMI independently predicts minor wound-related complications but not major complications. Major morbidity is more strongly influenced by comorbidities such as hypertension and smoking. These findings support individualized risk assessment and comorbidity optimization rather than rigid BMI cutoffs when counseling patients for reduction mammaplasty.
INTRODUCTION: Bacterial colonization of breast implants can lead to infections and capsular contracture, making contamination prevention essential. While conventional UVC254 light is germicidal, it poses risks to human s...INTRODUCTION: Bacterial colonization of breast implants can lead to infections and capsular contracture, making contamination prevention essential. While conventional UVC254 light is germicidal, it poses risks to human skin and eyes. In contrast, UVC222 effectively kills bacteria without harming mammalian cells due to limited stratum corneum penetration. This study investigates whether UVC222 irradiation can reduce bacterial density on breast implant shells and the epidermis of the submammary fold. MATERIAL AND METHODS: This prospective, single-center study included 31 patients who underwent breast reduction surgery between August 1, 2023, and June 1, 2024. Finely microtextured implant shells (MESMO ®, POLYTECH Health and Aesthetics GmbH, Germany) were placed on the sterile, washed submammary fold prior to skin incision. The implant shells were either irradiated with UVC222 using a KrCl excimer lamp (STERILSYSTEMS GmbH, Austria) or left untreated. Additionally, full-thickness skin samples from the submammary fold were irradiated or used as controls. Microbiological analysis was performed on all samples. RESULTS: UVC222 exposure significantly reduced bacterial density and microbial diversity on both implant shells (p = 0.0009) and skin samples (p = 0.02), with coagulase-negative staphylococci species being the most prevalent microorganisms in both treated and untreated groups. CONCLUSION: This pilot study shows that UVC222 effectively reduces bacterial density on breast implant surfaces and submammary fold epidermis, supporting its potential as an intraoperative sterilization tool. Further studies are needed to assess long-term safety and efficacy in surgical settings.
INTRODUCTION: Distinguishing between the zygomaticotemporal nerve (ZTBTN) and auriculotemporal nerve (ATN) as the principal trigger site for temporal migraines remains challenging. We provide an algorithm of surgical man...INTRODUCTION: Distinguishing between the zygomaticotemporal nerve (ZTBTN) and auriculotemporal nerve (ATN) as the principal trigger site for temporal migraines remains challenging. We provide an algorithm of surgical management of temporal migraines based on the senior author's 25-year experience. METHODS: Retrospective review of patients who underwent ATN or ZTBTN deactivation for temporal migraine headaches was performed. Demographic, clinicalm and questionnaire data were collected. Wilcoxon rank sum test for continuous variables and chi-square or Fischer's exact tests for categorical variables were used. RESULTS: Analysis of 151 patients (ATN: n = 114, ZTBTN: n = 74) was performed, with 91% (n = 133) of patients experiencing greater than 50% migraine reduction and 65.7% (n = 99) with complete symptom elimination. Indications for successful surgery are pain at the non-hairbearing region anterior to the hairline (p < 0.01) and frontal trigger sites (p = 0.01) for the ZTBTN cohort, and preoperative preauricular pain (p < 0.01) in the ATN cohort. Sixty one patients (40.3%) who did not have complete elimination of migraine symptoms underwent subsequent reoperations to the same (n = 39, 25.8%) or different temporal trigger site (n = 22, 14.6%). Complications occurred in 4.6% of patients, including neuroma (n = 4, 2.6%), surgical site infection (n = 2, 1.3%), and wound dehiscence (n = 1, 0.7%). CONCLUSION: This algorithm provides a straightforward clinical tool to distinguish between the ATN and ZTBTN peripheral trigger sites in the surgical management of temporal migraines.
BACKGROUND: Breast implant-associated squamous cell carcinoma (BIA-SCC) has emerged as a rare but aggressive malignancy with a mortality rate of 25% at 1 year. Its pathogenesis remains uncharacterized. METHODS: Breast im...BACKGROUND: Breast implant-associated squamous cell carcinoma (BIA-SCC) has emerged as a rare but aggressive malignancy with a mortality rate of 25% at 1 year. Its pathogenesis remains uncharacterized. METHODS: Breast implant capsules from women 18 to 80 years old were systematically sampled in six locations at a single institution. Samples were analyzed for squamous marker expression including p63, p40, and cytokeratin 5 (CK5) using PCR. Immunohistochemistry was used to assess presence of proteins and squamous metaplasia. RESULTS: 23 breast implant capsules were analyzed for squamous-related gene expression. Compared to those with implants in place for less than 10 years (n=11), the cohort with implants in place for more than 10 years (n=12) had 26.9 times higher CK5 expression (p=0.02), 39.8 times higher p40 expression (p=0.001), and 54.2 times higher p63 expression (p<0.001). After adjusting for implant duration, there were no differences in squamous-related gene expression regarding implant type or texture or the presence of capsular contracture or implant rupture. Samples directly under pectoralis had 20.2 times higher CK5 expression (p=0.02), 45.9 times higher p40 expression (p=0.002), and 12.7 times higher p63 expression (p=0.04) compared to samples directly under breast or skin. CONCLUSIONS: These findings support a chronic inflammatory pathogenesis similar to Marjolin ulcer. Our results challenge the previous theory that BIA-SCC arises from entrapped ductal epithelium. Instead, we propose that the epithelial cells originate from local capsule cells such as fibroblasts or macrophages that undergo metaplasia. We also propose that mechanical stress from muscular contraction may induce a chronic wound repair-like process.
BACKGROUND: Current methodological approaches in vascularized composite allotransplantation (VCA) research demonstrate significant limitations in functional recovery assessment, necessitating endpoint histological evalua...BACKGROUND: Current methodological approaches in vascularized composite allotransplantation (VCA) research demonstrate significant limitations in functional recovery assessment, necessitating endpoint histological evaluation and exhibiting inadequate correlation with human hand transplantation physiology. This investigation establishes a novel mystacial pad transplantation (MPT) model incorporating advanced neuroimaging technologies to enable comprehensive real-time functional assessment of sensorimotor recovery mechanisms. METHODS: Fifteen 8-12-week-old Lewis rats underwent allogeneic orthotopic MPT from Brown Norway donors with serial evaluations extending to 3 months post-transplantation. Functional recovery assessment utilized blood oxygen level-dependent (BOLD) functional magnetic resonance imaging to evaluate cortical activation patterns. Vascular integrity was monitored through high-resolution ultrasound biomicroscopy, while peripheral nerve regeneration was quantified through histomorphometric assessment of myelinated axon density at neural coaptation sites. RESULTS: Surgical procedures achieved an 80% success rate with standardized microsurgical techniques. BOLD signal responses demonstrated significant cortical activation (p-values ranging from 10⁻⁵ to 10⁻⁸) in contralateral S1BF, S2, and S1ULp regions. Ultrasound biomicroscopy revealed patent vascular anastomoses without transplant vasculopathy throughout the observation period. Histomorphometric quantification demonstrated 11% and 37% myelinated axon reduction at coaptation and distal sites respectively, with electron microscopic examination confirming successful nerve regeneration characterized by appropriate Schwann cell presence and robust myelination patterns. CONCLUSIONS: The mystacial pad transplantation model provides validated methodological capabilities for investigating functional recovery mechanisms in vascularized composite allotransplantation research through real-time assessment integration, with demonstrated correlation between incomplete anatomical regeneration and substantial functional recovery indicating cortical neuroplasticity compensation mechanisms that inform clinical transplantation outcome optimization strategies.
BACKGROUND: Gender affirming mastectomy surgery, also known as top surgery, is known to improve psychological health and quality of life for transgender and gender diverse patients, but little is known about effects on p...BACKGROUND: Gender affirming mastectomy surgery, also known as top surgery, is known to improve psychological health and quality of life for transgender and gender diverse patients, but little is known about effects on physical health. 1 This study examines how baseline demographics and gender affirming mastectomy surgery impact longer-term lifestyle behaviours. METHODS: Gender affirming mastectomy patients, aged 18+, were recruited from Women's College Hospital and McLean Clinic. A survey was administered preoperatively (T1), 4 months postoperatively (T2), and 1 year postoperatively (T3). The survey consisted of the Short Multidimensional Inventory Lifestyle Evaluation, a self-assessment tool. Data was analyzed with ANOVA, Kruskal Wallis, and Wilcoxon signed rank tests using RStudio. RESULTS: 288 patients were eligible and 234 patients consented. 166 completed the survey at T1 (71%). Patients with higher household incomes and education scored better (p=0.003; p=0.0003). Household income had the largest impact on social supports (p=0.03); higher education was associated with better diet and stress management (p=0.001; p=0.0004). 109 patients completed the survey at T2 (66%). The total score was equivalent (p=0.19). At T3, 103 patients completed the survey (62%). Between T1 and T3, the total score increased from 75.66 to 78.06 (p=0.003). The scores improved in nutrition (p=0.01), physical activity (p=0.03), stress management (p=0.001), restorative sleep (p=0.01), and environmental exposures (p=<0.01). CONCLUSIONS: Social determinants of health can play a significant role in lifestyle behaviours in TGD patients. This study found long-term improvements between pre- and postoperative lifestyle behaviours and across several domains. Further research should examine effects of gender affirming surgery across a longer timeframe.