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  A Retrospective Review of Cosmetic Surgery Medical Tourism Complications During COVID-19 Pandemic

  Rachel Blaisdell, Claire McNary, Catherine Barkach, Emanuela Peshel, Elizabeth Boudiab, Lauren Oliver, and Samuel Mucci

  Publication Date: 5-2024

  • Cosmetic surgery medical tourism refers to traveling outside one’s geographic region for the purpose of a cosmetic procedure
  • Benefits include reduced cost, shorter wait times, and newer “trendy” procedures
  • Potential problems include a lack of continuity of care for patients, travel after surgery, and exposure to foreign pathogens

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  Comparing Plastic Surgeon Operative Time for Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction

  Christopher J. Issa, Elizabeth M. Boudiab, Jeffrey DeSano, Neil S. Sachanandani, Jeremy Powers, and Kongkrit Chaiyasate

  Publication Date: 5-2024

  The deep inferior epigastric perforator (DIEP) flap has remained the gold standard for perforator flap reconstruction due to its consistent anatomy and low morbidity. Despite higher longterm patient satisfaction in autologous breast reconstruction compared to breast implants,1–3 implant-based reconstruction remains more common due to shorter operative time.

  Several studies have examined the issue of optimizing efficiency of autologous breast reconstruction but were typically performed in the context of immediate reconstruction. In our institution and others, however, two-stage delayed reconstruction is the norm — a tissue expander is placed at the first stage for preservation of the skin envelope; after expansion and any adjuvant therapies are completed, the expanders are removed and replaced with DIEP flaps in a second stage.

  The primary objective of this study was to compare the plastic surgeon’s operative time between DIEP flap reconstruction immediately following mastectomy (single-stage), versus immediate placement of tissue expander(s) followed by delayed DIEP flap reconstruction (two-stage). Secondary objectives included comparing total patient time under anesthesia and overall complications. We hypothesized that the operative time for the plastic surgeon to place tissue expanders and then return at a later date to perform free flap reconstruction would be the same or less than the time required for immediate flap reconstruction at the time of mastectomy.

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  Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy

  Patrick Thrasher, Ronald Levitin, Bryan S. Squires, Allison J. Hazy, Michael J. Maywood, Anthony P. Delise, Muayad F. Almahariq, Nayana Dekhne, Lauren Oliver, Peter Y. Chen, Kailee J. Walters, Diane Dudley, and Joshua T. Dilworth

  Publication Date: 5-2024

  Postmastectomy radiation therapy (PMRT) utilized as part of a breast cancer treatment regimen reduces the risk of disease recurrence in appropriately selected patients.1,2,3,4,5 However, PMRT increases risk of radiationrelated toxicities that can interfere with breast reconstruction post-mastectomy.6 Following mastectomy, implant-based reconstruction can increase patient satisfaction and quality of life7,8; complications induced by PMRT such as infection and tissue contracture, though, increase risk for implant loss and may ultimately require further surgeries for the patient.

  PMRT is delivered based on treatment plans that are optimized to provide appropriate radiation dosages to tissues along the chest wall while simultaneously limiting exposure of surrounding sensitive structures. Subcutaneous lymphatic structures and residual glandular tissue are of major importance as they may harbor microscopic disease that can lead to recurrence.9 The skin and immediate surrounding tissue, therefore, is often exposed to higher doses of radiation to ensure appropriate therapeutic coverage of these structures. How this increased dose delivery may affect a patient’s risk for radiation-related toxicities, however, is currently not well characterized. We hypothesize that near-surface dose to the reconstructed chest wall predicts for an increased risk of significant breast pain as well as the development of acute skin toxicities such as moist desquamation. Identifying dosimetric correlates for these acute toxicities may allow for optimization of radiation treatment planning aimed at reducing the incidence of acute toxicities and further associated complications.