Bernard, Robert W.

Background: Conflicts of interest pose a risk to the integrity of clinical research. As part of the Sunshine Act, the Open Payments Program was established to provide transparency in financial relationships between commercial entities and physicians. Previous research indicates disparities between industry payments self-reported by plastic surgeon authors and those disclosed by commercial entities. This study sought to revisit the accuracy of conflict-of-interest disclosures, comparing current trends with previously published data, and introduce a novel automated search tool designed to facilitate future reviews of self-disclosures. Methods: Articles from the Aesthetic Surgery Journal and Plastic and Reconstructive Surgery published between 2017 and 2022 were reviewed. Self-reported disclosures for plastic surgeon authors were aggregated and compared against the Open Payments database using Python. Results: A total of 8040 articles were reviewed. After filtering and applying inclusion criteria, 961 unique authors and 4226 authorships were identified. A total of 5802 discrepancies were found, with 78.6% of eligible authors having at least 1 discrepancy. Four percent of the included publications were estimated to contain undisclosed relationships that qualified as conflicts of interest. The median total payments for authors with discrepancies were greater than for authors without discrepancies ($9600 vs. $2500; P <0.001). A discrepancy in self-reporting was more likely to be identified among senior authors ( P <0.001). Conclusions: Plastic surgeon authors continue to underreport their financial relationships. Automated screening may help identify disclosure discrepancies and support more complete author self-reporting.

As plastic surgery has grown, leaders within the field have advocated transforming plastic surgery divisions into independent departments. This shift raises critical questions regarding departmental identity, resource allocation, and potential administrative conflicts. The purpose of this study was to explore the potential implications of these institutional hierarchies from the perspective of plastic surgery program chairs. An anonymous online survey was distributed to chairs of accredited plastic surgery programs. Thirty-five of 103 (34.0%) individuals responded to the online questionnaire. Twenty-eight of 33 (84.8%) programs were classified as divisions of surgery, whereas 5 of 33 (15.2%) were independent departments. Nine of 28 (32.1%) respondents believed their division had lost patients to other surgical specialties because their program was not an independent department. Eighteen of 33 (54.5%) respondents believed that plastic surgery is negatively impacted when institutional programs are not independent departments. Respondents who indicated losing patients to other specialties, compared with those who did not, were 22.4 times more likely to be critical of institutional hierarchies ( P =0.004). Respondents from independent departments were 12.6 times more likely to also express a negative view ( P =0.049). Our findings provide a nuanced understanding of the institutional structures within plastic surgery programs. The extent to which institutional hierarchies negatively impact plastic surgery remains unclear. The significant association between patient loss and negative perceptions implies that direct clinical or financial repercussions strongly shape opinions. Moreover, chairs from independent departments may be more critical of institutional hierarchies because they have a deeper appreciation for the advantages that come with departmental status.

Abstract Background During the past decade, a growing number of women have pursued medical careers, including in plastic surgery. However, female physicians have tended to be underrepresented in a variety of leadership roles in their respective specialties. Objectives The authors sought to evaluate the representation of female plastic surgeons on the editorial boards of high-impact plastic surgery journals. Methods The gender of editorial board members on 3 high-impact plastic surgery journals was evaluated from 2009 and 2018. The number of women on each editorial board was then compared with the number of board-certified female plastic surgeons (BCFPS) and board-certified female academic plastic surgeons (BCFAPS), a subgroup of BCFPS. Results There were 555 unique editorial board members from Plastic and Reconstructive Surgery, Aesthetic Surgery Journal, and Annals of Plastic Surgery from 2009 to 2018. During that period, 72 editors (13.0%) were women. At the beginning of the study, there were significantly fewer female editors than expected based on proportionate representation of BCFPS and BCFAPS to all board-certified plastic surgeons (P = 0.007 and 0.007, respectively). During the study, there was a 177% increase in women holding editorial board positions. At study end, women were adequately represented on all 3 editorial boards compared with their population data (BCFPS and BCFAPS). Conclusions During the 10 years of this study (2009-2018), editorial boards have overcome the underrepresentation of women on, and female plastic surgeons are currently adequately represented on the top 3 high-impact journal editorial boards.

Abstract Pyoderma gangrenosum (PG) is a rare, inflammatory dermatologic condition characterized by painful cutaneous ulcerations. Herein, we describe the third documented case of PG arising in an elective plastic surgery patient who had undergone an otherwise uncomplicated facelift. We describe the course of her diagnosis and management of PG, which involved her face and neck and then progressed to her lower extremities. Although the etiology remains unknown, PG often arises in a host with another autoimmune disease. In the case described, the patient was diagnosed with an immunoglobulin A gammopathy shortly after she developed PG. Following the case report, the pathogenesis, diagnosis, and treatment strategy of PG is briefly reviewed. Level of Evidence: 5

Abstract Background Recent data show that aesthetic surgery research is lagging compared with reconstructive surgery: research funding and institutional disparities within aesthetic surgery are potential factors in this trend. Objectives The authors sought to determine if disparities exist in aesthetic surgery research based on funding sources or practice settings. Methods The authors reviewed Aesthetic Surgery Journal articles from 2009 to 2019. Chi-square, t test, bivariate, and multivariate regression analyses were employed to evaluate research trends. Results A total of 2262 publications were identified, with 318 funded articles meeting inclusion criteria. The majority of studies (294, 92%) received external funding, with 281 (88%) being supported solely by external funds. Externally funded studies were financed by private industry (194, 66%), foundations/societies (53, 18%), government grants (23, 8%), or a combination of agencies (24, 8%). The majority of funded studies were at academic institutions (266, 84%), followed by private practice (46, 14%) and private industry (6, 2%). Analysis of annual publications revealed a rising percentage of academic-based research, which correlated with decreasing research from private practice (r = −0.95, r2 = 0.89, P &lt; 0.001). Compared with academic institutions, private practice relied more heavily on industry funding (55% vs 87%, respectively, P = 0.001), exhibiting lower rates of foundational/societal (20% vs 2%), governmental (9% vs 0%), combined (8% vs 7%), and internal department funding (8% vs 4%). Article citations and level of evidence were unaffected by funding source, agency, or practice setting. Conclusions Lack of diversity in research funding among private practice surgeons may explain the reported discrepancies that currently exist between aesthetic and reconstructive surgery research.

Background The purpose of this study is to evaluate how prior breast augmentation impacts rates of complications and risk for reoperation after mastectomy with concurrent breast reconstruction. Methods Patients undergoing nipple-sparing, skin-sparing, or simple mastectomy with implant-based reconstruction from 2008 to 2018 were identified in a prospective database. Postoperative complications and reoperations were then analyzed comparing patients with prior augmentation to patients without history of previous breast surgery. Results A total of 468 patients were identified with a median follow-up of 4 years. Of these, 72 had prior augmentation mammoplasty. These patients underwent nipple-sparing (52, 72%), skin-sparing (15, 21%), or simple (5, 7%) mastectomy with immediate direct-to-implant (46, 61%) or tissue expander (26, 35%) reconstruction. On univariate analysis, this cohort had a lower body mass index (23.3 vs 25.3, P = 0.003), a higher rate of nipple-sparing mastectomy (72% vs 54%, P = 0.01), and a higher prevalence of stage I disease (44% vs 33%, P = 0.04). Differences in age, comorbidities, reconstructive techniques, tumor size, and neoadjuvant/adjuvant therapies were not significant. Overall complication rate between patients with or without prior augmentation did not significantly differ (51% vs 50%, P = 0.83); no significant differences in rates of surgical site infection, hematoma, mastectomy skin flap/wound necrosis, nipple complications, implant loss, or capsular contracture were found. Analysis of reoperations between patients with and without prior augmentation revealed no significant differences in average number of subsequent planned, unplanned, or total reoperations. On multivariate analysis, prior breast augmentation was found to be associated with significantly increased risk for undergoing ≥1 unplanned reoperation (odds ratio, 2.28; 95% confidence interval, 1.28–4.05, P = 0.005). Conclusions Prior augmentation mammoplasty does not significantly affect rates of postoperative complications after mastectomy with concurrent reconstruction. Although prior augmentation does not affect number of subsequent reoperations on average, it does increase the risk of experiencing 1 or more unplanned reoperation after mastectomy with reconstruction.

Abstract Background Deep venous thrombosis and pulmonary embolism, collectively known as venous thromboembolism (VTE), are among the most feared yet preventable surgical complications. Although many recommendations exist to reduce the risk of VTE, the actual VTE prophylaxis practices of aesthetic plastic surgeons remain unknown. Objectives The primary aim of this study was to elucidate plastic surgeons’ experiences with VTE, preferred VTE prophylaxis practices, and areas in which VTE prevention may be improved. Methods Members of The Aesthetic Society were queried via a 55-question electronic survey regarding their experience with VTE as well as their VTE prophylaxis practices. Anonymous responses were collected and analyzed by the Mayo Clinic Survey Research Center. Results The survey was sent to 1729 of The Aesthetic Society members, of whom 286 responded. Fifty percent, 38%, and 6% of respondents reported having had a patient develop a deep venous thrombosis, pulmonary embolism, or death secondary to VTE, respectively. Procedures performed on the back or trunk were associated with the highest rate of VTE. Lower extremity procedures were associated with a significantly higher rate of VTE than expected. Over 90% of respondents reported utilizing a patient risk stratification assessment tool. Although at least one-half of respondents reported that the surgical facility in which they operate maintains some form of VTE prophylaxis protocol, 39% self-reported nonadherence with these protocols. Conclusions Considerable variability exists in VTE prophylaxis practices among The Aesthetic Society responders. Future efforts should simplify guidelines and tailor prophylaxis recommendations to the aesthetic surgery population. Furthermore, education of plastic surgeons performing aesthetic surgery and more diligent surgical venue supervision is needed to narrow the gap between current recommendations and actual practices.