Although certain medical societies have released guidelines on the use of social media, plastic surgery, with its inherent visual nature and potential for sensationalism, could benefit from increasing direction regarding the ethical use of social media. The authors hypothesized that although general platitudes for use exist in the literature, guidelines articulating the boundaries of professional use are nonspecific. Systematic searches of MEDLINE, Embase.com, and Cochrane Central Register of Controlled Trials were completed on January 18, 2017. Searches consisted of a combination of Medical Subject Headings terms and title and abstract keywords for social media and professionalism concepts. In addition, the authors manually searched the three highest impact plastic surgery journals (ending in October of 2017). Two authors screened all titles and abstracts. Studies related to clinical medicine, patient care, and the physician-patient relationship were included for full-text review. Articles related to surgery merited final inclusion. The initial search strategy yielded 954 articles, with 28 selected for inclusion after final review. The authors' manual search yielded nine articles. Of the articles from the search strategy, 10 were published in the urology literature, eight were published in general surgery, six were published in plastic surgery, three were published in orthopedic surgery, and one was published in vascular surgery. Key ethical themes emerged across specialties, although practical recommendations for professional social media behavior were notably absent. In conclusion, social media continue to be a domain with potential professional pitfalls. Appropriate use of social media must extend beyond obtaining consent, and plastic surgeons must adhere to a standard of professionalism far surpassing that of today's media culture.

No abstract

AlloDerm (LifeCell, Branchburg, NJ) is gaining acceptance in tissue expander/implant (TE/I) breast reconstruction. Anecdotal evidence suggests its use limits postoperative musculoskeletal morbidity and allows injection of greater initial fill-volumes and rapid postoperative expansion. The objective of this study was to evaluate AlloDerm's impact on expansion rates in immediate TE/I reconstruction. A matched, retrospective cohort study was performed. Medical records of patients who underwent immediate TE/I reconstruction from 2004 to 2005 were reviewed. Two cohorts were identified: (1) underwent TE/I reconstruction with AlloDerm, and (2) underwent standard TE/I reconstruction. Individuals were matched 1:1 on the basis of: expander size (+/-100 mL), history of irradiation, and indication for mastectomy. Cohorts were compared for intraoperative volume injected (mL), rate of postoperative expansion (mL/ injection), number of expansions, and time to completion of expansion (days). Incidence of complications was evaluated. Pairwise comparisons were performed using the Wilcoxon sign rank test and McNemar test. Ninety immediate TE/I reconstructions were evaluated. Forty-five TE/I-AlloDerm reconstructions were matched to standard TE/I reconstructions. Intraoperatively, expanders in the AlloDerm and non-AlloDerm cohorts were filled to a mean volume of 223.8 and 201.1 mL (P = 0.180). Median number of expansions performed was 5 and 6 in the AlloDerm and non-AlloDerm cohorts (P = 0.117). There was no difference in the mean rate of postoperative tissue expansion (AlloDerm: 97 mL/injection versus non-AlloDerm: 95 mL/injection [P = 0.907]), nor in the incidence of complications (P = 0.289). Minor complications occurred in 13.1% of AlloDerm cases (cellulitis [n = 3], seroma [n = 3], hematoma [n = 1]. Although this study does not address AlloDerm's efficacy in decreasing morbidity or improving esthetic outcomes in TE/I reconstruction, it indicates that AlloDerm does not increase the rate of tissue expansion after immediate TE placement. It does not, however, appear to increase the risk of postoperative complications.

Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.

No abstract

No abstract

To fully evaluate the cost difference between these procedures, a cost-effectiveness analysis must be performed that incorporates quality-of-life data. Such data would significantly affect assessments of the cost difference between implant and autogenous tissue reconstruction.

The authors advocate limited sternal debridement and partial bilateral pectoralis major myocutaneous advancement flaps in patients with limited wounds and partially or fully healed sternums. We demonstrate that the procedure is effective but less invasive than complete debridement, reduces operative time and blood loss, and shortens length of hospitalization.