LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Name the 3 major subtypes of breast implant-associated (BIA) malignancies. 2. Recognize the most common presenting symptoms of BIA m...LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Name the 3 major subtypes of breast implant-associated (BIA) malignancies. 2. Recognize the most common presenting symptoms of BIA malignancies. 3. Identify appropriate treatment options for each BIA malignancy, including chemotherapy, radiation, and surgery. 4. Answer patient questions about recurrence and reconstruction after a diagnosis of BIA malignancy. SUMMARY: Although rare, breast implants have been associated with several malignancies, categorized into 3 major subtypes: BIA anaplastic large-cell lymphoma, B-cell lymphoma, and squamous cell carcinoma. BIA anaplastic large-cell lymphoma is the most common subtype, with more than 1700 cases reported to date. BIA squamous cell carcinoma is the most aggressive subtype. The most common presenting symptom is late seroma. Patients typically report pain and swelling. Workup should begin with an ultrasound or mammography, and any fluid collections should be aspirated and evaluated in conjunction with pathology. The authors provide an algorithm for surgical excision and adjuvant treatment based on disease stage and subtype.
OBJECTIVES: To compare early and long-term patient-reported outcomes following dorsal preservation rhinoplasty (DPR) versus conventional hump reduction (CHR) in patients undergoing primary nasal dorsal reduction. METHODS...OBJECTIVES: To compare early and long-term patient-reported outcomes following dorsal preservation rhinoplasty (DPR) versus conventional hump reduction (CHR) in patients undergoing primary nasal dorsal reduction. METHODS: We conducted a retrospective cohort study of 377 patients who underwent DPR (n = 178) or CHR (n = 199) between 2017-2024. Outcomes were assessed using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and visual analog scale (VAS) scores at baseline and at 3, 6, 12, and 24 months postoperatively. Multivariate linear regression adjusted for age, sex, and baseline symptom severity. RESULTS: In unadjusted analyses, DPR was associated with lower SCHNOS-C scores and higher VAS-C scores at 3 and 6 months postoperatively compared with CHR, although the absolute differences were modest. After multivariable adjustment, DPR was independently associated with improved SCHNOS-C scores at 6 months, but not at 3 months. No significant differences in aesthetic outcomes were observed at 12 or 24 months. Functional outcomes were similar between groups across all time points. Patients who underwent CHR more frequently underwent midvault reconstruction with spreader grafts or autospreaders, anterior septal reconstruction (ASR), and clocking sutures, whereas DPR patients frequently underwent supratip, radix, and underlay articulated rim grafting. CONCLUSION: DPR was associated with modest, early improvements in patient-reported aesthetic outcomes that reached statistical significance at 6 months after adjustment, with convergence of aesthetic and functional outcomes thereafter. These findings are associative rather than causal and emphasize the importance of patient selection and underlying nasal anatomy in guiding surgical technique.Level of Evidence: 3.
PURPOSE: The quality of systematic reviews relies on the inclusion of published and unpublished clinical trials. Unpublished trials often report statistically non-significant results, which if included in systematic revi...PURPOSE: The quality of systematic reviews relies on the inclusion of published and unpublished clinical trials. Unpublished trials often report statistically non-significant results, which if included in systematic reviews would likely alter study conclusions. This study aims to evaluate whether systematic reviews in hand surgery literature conduct searches of clinical trial registries. METHODS: PubMed was searched comprehensively to identify all systematic reviews on hand surgery topics. We evaluated articles from both the Cochrane Database of Systematic Reviews (CDSR) and the five journals with the greatest number of published systematic reviews discussing hand surgery topics to determine whether they conducted clinical trial registry searches. A secondary analysis of the articles that did not conduct a registry search was done to identify unpublished trials from ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP). RESULTS: Only 5% of hand surgery related systematic reviews from high-impact journals conducted a clinical trial registry search. In contrast, 100% of the systematic reviews published in CDSR conducted at least one clinical trial registry search. Of the articles that did not perform a registry search, 14% had trial data that could have been included in the article's findings. Literature searches performed after April 2019, the date when ClinicalTrials.gov and WHO-ICTRP records were added to CENTRAL's database, had a lower frequency of CENTRAL searches. CONCLUSIONS: The frequency of clinical trial registry searches in hand surgery systematic reviews is markedly low. Searches of relevant clinical trial registries should be done in accordance with current Cochrane guidelines.
INTRODUCTION: Nasoalveolar molding (NAM) is a presurgical technique used to improve nasolabial cleft severity prior to repair. This study ascertains the rates of revision surgery in a large cohort of patients with a clef...INTRODUCTION: Nasoalveolar molding (NAM) is a presurgical technique used to improve nasolabial cleft severity prior to repair. This study ascertains the rates of revision surgery in a large cohort of patients with a cleft who underwent NAM and were followed to facial maturity. METHODS: A single-institution retrospective review of all patients with a cleft who underwent NAM from 1995 to 2005 was performed. Operative reports were queried to record intervnetions to the lip and nose performed through facial maturity. Patients with incomplete medical records prior to reaching skeletal maturity were excluded. Pearson correlation coefficient and two-paired student t-tests were employed for data analysis. RESULTS: A total of 81 patients were studied, 46 male and 35 female, with 52(64%) unilateral and 29(36%) bilateral clefts. Average age at last follow-up was 18.8 years. Revision to the lip was carried out in 36(44%) of patients, and only 3(3.7%) prior to reaching facial maturity. Re-repair was performed in 10(12%) patients. No significant difference of lip revisions rates were seen among patients with a bilateral and unilateral cleft (48% v. 37.9%, p=0.38).Immature cleft rhinoplasty was performed in 3(4%) patients, and more commonly among patients with a unilateral (23%) than bilateral cleft (10%), p=0.18. Mature rhinoplasty was performed in 46(57%) patients, similarly between unilateral (58%) and bilateral clefts (55%). Nasal revision following mature rhinoplasty was performed in 8(10%) patients. CONCLUSIONS: Nasoalveolar molding is an effective adjunct to surgical management in reducing the burden of operative revisions as patients reach facial maturity, namely for bilateral clefts.
BACKGROUND: This study compared sensory and patient-reported outcomes following single- versus dual-nerve coaptation in autologous breast reconstruction. METHODS: In a prospective cohort study (2022-2025), women undergoi...BACKGROUND: This study compared sensory and patient-reported outcomes following single- versus dual-nerve coaptation in autologous breast reconstruction. METHODS: In a prospective cohort study (2022-2025), women undergoing nipple- or skin-sparing mastectomy with immediate deep inferior epigastric perforator flap reconstruction received single- or dual-nerve coaptation (one vs two donor-to-recipient sensory nerve coaptations). Tactile thresholds (g/mm²) were measured across nine breast regions using a Pressure-Specified Sensory Device preoperatively and at 3, 6, and 9 months. BREAST-Q surveys were administered at 9 months. RESULTS: Fifty patients (91 breasts) were included (dual: 23 patients/43 breasts; single: 27 patients/48 breasts), with comparable baseline characteristics (p > 0.05).Recovery was similar at 3 months (37.3% vs 39.5%, p = 0.71), diverged at 6 months (43.5% vs 56.8%, p = 0.08), and was significantly greater with dual coaptation at 9 months (48.0% vs 65.6%, p = 0.04). At 6 months, dual coaptation demonstrated greater recovery in the outer superior (87.8% vs 41.1%, p < 0.001) and inner lateral (47.5% vs 23.4%, p = 0.029) regions. At 9 months, significant differences were observed in the outer superior (84.3% vs 51.4%, p = 0.008), outer lateral (80.6% vs 55.3%, p = 0.047), and inner lateral (56.6% vs 32.8%, p = 0.027) regions.At 9 months, BREAST-Q Sensation and Psychosocial Well-Being scores were higher in the dual-neurotized cohort (2.09 vs 1.41, p = 0.03; 3.11 vs 2.42, p = 0.01). CONCLUSIONS: Dual-nerve coaptation is associated with greater tactile recovery and higher patient-reported sensation and psychosocial well-being than single-nerve coaptation.