Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction? Background: Obesity has reached epidemic proportions, with 72 million people in the United States classified as obese in 2010. This significant increase in obese patients is reflected in the breast cancer population seeking breast reconstruction. Previous studies demonstrated increased complication rates and decreased satisfaction in obese patients undergoing breast reconstruction. This study aims to directly compare prosthetic and autologous reconstruction in the obese population by evaluating surgical outcomes and patient satisfaction. Methods: In an institutional review board–approved study, a retrospective chart review was conducted on patients with a body mass index of 30.0 kg/m2 or greater who underwent breast cancer reconstruction after mastectomy with either free tissue transfer from the abdomen or prosthetic reconstruction over a 3-year period. The authors identified 96 patients with 141 reconstructions. Demographic, intraoperative, and postoperative variables were collected. All patients were sent the BREAST-Q questionnaire by means of mail to study the impact and effectiveness of breast surgery from the patient’s perspective. Statistical analysis was completed with Fisher’s exact test, Mantel-Haenszel chi-square test, Pearson chi square test, or Mann-Whitney-Wilcoxon test. Results: Prosthetic-based breast reconstruction was associated with increased major breast complications (p < 0.001), mastectomy skin flap necrosis (p = 0.009), infection (0.006), and overall reconstructive failure (p < 0.0001) compared with autologous reconstruction. When evaluating the results of the BREAST-Q studies, the autologous reconstruction group had improved satisfaction with breasts (p < 0.0001), satisfaction with outcome (p = 0.01), psychosocial well-being (p = 0.007), and sexual well-being (p = 0.006). Conclusion: In the obese population, reconstruction with free tissue transfer from the abdomen resulted in decreased complications of the breast reconstruction site and improved patient satisfaction with outcomes compared with prosthetic reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Discussion: Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction? No abstract available

Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy Background: Complications from breast reconstruction may delay postmastectomy radiation therapy and impact breast cancer outcomes. The authors hypothesized that immediate breast reconstruction may be associated with delays in the initiation of radiation, but that this delay would not significantly impact overall patient survival. Methods: Using the National Cancer Database, the authors identified women with breast cancer who underwent mastectomy and received postmastectomy radiation therapy. Delayed radiation was defined as treatment initiated 6 months or more after surgery in patients who received adjuvant chemotherapy or 12 weeks or more after surgery in patients who received neoadjuvant or no chemotherapy. Results: Women undergoing breast reconstruction had an increased time to postmastectomy radiation therapy, 154 days versus 132 days (p < 0.001), and were more likely to experience a delay in initiating radiation (OR, 1.25; 95 percent CI, 1.188 to 1.314). Other factors associated with delayed radiation included increased Charlson/Deyo scores, neoadjuvant chemotherapy, nonprivate insurance, and black race. Cox proportional hazards models revealed no evidence of a reduced adjusted overall survival in the immediate breast reconstruction group (hazard ratio, 0.836; 95 percent CI, 0.802 to 0.871; p < 0.001). Restricted cubic spline analysis identified the threshold number of days at which the start of radiation began to impact survival at 169 days (95 percent CI, 160 to 190 days), 75 days (95 percent CI, 42 to 90 days), and 71 days (95 percent CI, 41 to 90 days) in patients undergoing adjuvant, neoadjuvant, and no chemotherapy, respectively. Conclusion: Immediate breast reconstruction is associated with a modest delay in initiating postmastectomy radiation therapy but does not impact overall survival. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Discussion: Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy No abstract available

Effect of Body Mass Index on Outcomes after Prepectoral Breast Reconstruction Background: Body mass index has been shown to be a predictor of outcomes after subpectoral expander/implant reconstruction, with every unit increase in body mass index increasing the risk of complications by approximately 6 percent. The effect of body mass index on complications after prepectoral reconstruction has not yet been evaluated and is the purpose of this study. Methods: A total of 366 reconstructed breasts from 197 patients were stratified into five body mass index groups (normal; overweight; and class I, class II, and class III, obese) and postoperative complications were compared across the groups. Additional analyses were performed using broad classifications of body mass index into nonobese and obese in addition to normal, overweight, and obese. Body mass index as an independent predictor of complications was assessed using multivariate logistic regression analysis. Results: Complication rates did not differ significantly across body mass index groups when using the broad classifications. With five-group stratification, significantly higher rates of return to operating room, expander/implant loss, skin necrosis, wound dehiscence, and overall complications were seen in class II and/or class III obese versus overweight patients. However, on multivariate logistic regression analyses, body mass index, as a continuous variable, did not independently predict any complication. Diabetes and smoking emerged as significant predictors of any complication, indicating that these factors, rather than body mass index, were driving the increased rates of complications seen in the high–body mass index groups. Conclusion: Body mass index alone is not a predictor of outcomes after prepectoral expander/implant breast reconstruction and should not be used to estimate risk of postoperative complications or exclude patients for prepectoral reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Are 30-Day Outcomes Enough? Late Infectious Readmissions following Prosthetic-Based Breast Reconstruction Background: Surgical-site infection is a major concern in prosthetic-based breast reconstruction. Thirty-day postoperative readmission rates are a common quality metric, but little is known about readmission rates for later infections. Methods: Using the 2013 to 2014 Nationwide Readmissions Database, the authors identified breast cancer patients undergoing breast reconstruction with implants and tissue expanders who had an infectious readmission. The authors used univariate and multivariate logistic regression models to identify predictors of infectious readmission and explantation within the early (0 to 30 days) and late (31 to 90 days) postoperative periods. Results: In the weighted sample, the authors identified 18,338 patients undergoing prosthetic-based breast reconstruction. The overall infectious readmission rate was 4.1 percent (n = 759): 49.3 percent occurred early and 50.7 percent occurred late. Of the infectious readmissions, 39.5 percent required explantation, 55.1 percent of which occurred during a late infectious readmission. Seventy-five percent of these infectious readmissions and explantations occurred within 49 days of initial surgery. Median annual household income less than $40,000 (p = 0.035), diabetes (p = 0.038), and obesity (p = 0.004) were independent predictors of infectious readmission. Diabetes (p = 0.049) and hypertension (p = 0.011) were independent predictors of early readmission. Median annual household income less than $40,000 (p = 0.049), obesity (p = 0.006), and increasing length of stay during the index procedure (p = 0.028) were independent predictors of late readmission. No statistically significant independent predictors for explantation were identified. Conclusions: Traditional 30-day readmission rates are not an adequate quality metric for breast reconstruction given the number of late postoperative readmissions, many of which lead to explantation. Early and late infectious readmissions have different predictors. Interventions targeting these predictors may decrease the number of readmissions, thus reducing cost and improving quality. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State Background: New York State passed the Breast Cancer Provider Discussion Law in 2010, mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstruction rates. This study examines the impact of this law. Methods: A retrospective cohort study of the New York State Planning and Research Cooperative System database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by sociodemographic factors and provider types. Results: The study included 32,452 patients. The number of mastectomies decreased from 6479 in 2008 to 5235 in 2013; the rate of reconstruction increased from 49 percent in 2008 to 62 percent in 2013. This rise was seen across all median income brackets, races, and age groups. When comparing before to after law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans and elderly patients, but the disparity in reconstruction rates did not change for other races, different income levels, or insurance types. Reconstruction rates were also not significantly different between those treated in various hospital settings. Conclusions: The aim of the Breast Cancer Provider Discussion Law is to improve reconstruction rates through provider-driven patient education. The authors’ data show significant change following law passage in African American and elderly populations, suggesting effectiveness of the law. The New York State Provider Discussion Law may provide a template for other states to model legislation geared toward patient-centered improvement of health outcomes.

Discussion: The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State No abstract available

Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience Background: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. Methods: One thousand seventy flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. Results: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. Conclusions: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Complications and Quality of Life following Reduction Mammaplasty in Adolescents and Young Women Background: Adolescent reduction mammaplasty remains controversial because of concerns of postoperative breast growth, complications, and the effect on well-being. The authors sought to prospectively quantify early and late complications following reduction mammaplasty in adolescents and young women, and examine the intersection of surgical complications and postoperative health-related quality of life. Methods: From 2008 to 2017, female patients aged 12 to 21 years undergoing reduction mammaplasty were asked to complete the 36-Item Short-Form Health Survey (version 2), the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, and the Eating-Attitudes Test-26 preoperatively and postoperatively at 6 months and 1, 3, 5, and 7 years. Clinical evaluations using standardized forms assessed baseline and postoperative symptomatology, complications, and surgical outcomes. Results: In the authors’ sample of 512 participants, the most common complications included hypertrophic scarring (20.0 percent) and altered sensation of the nipple (8.4 percent) or breast (7.8 percent). Patient age, body mass index category, and amount of tissue resected did not significantly increase the odds of developing a complication. Significant postoperative improvements on the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, the Eating-Attitudes Test-26, and in all 36-Item Short-Form Health Survey domains (i.e., physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) were largely seen irrespective of whether complications occurred. Conclusions: Although complications following reduction mammaplasty were common, the vast majority were minor. Patients had significant postoperative improvements in their physical and psychosocial well-being regardless of whether they experienced a complication. Concerns for potential complication, especially in younger and overweight or obese patients, should not preclude otherwise healthy adolescents and young women from the benefits of reduction mammaplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Breast         Original Articles   Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction? Kristen A. Klement, John B. Hijjawi, John A. LoGiudice, Mohammad Alghoul, Pamela Omesiete-Adejare Discussion: Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction? Rajiv P. Parikh, Terence M. Myckatyn Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy Ronnie L. Shammas, Yi Ren, Samantha M. Thomas, Scott T. Hollenbeck, Rachel A. Greenup, Rachel C. Blitzblau Discussion: Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy Allen Gabriel, G. Patrick Maxwell Effect of Body Mass Index on Outcomes after Prepectoral Breast Reconstruction Allen Gabriel, Steven Sigalove, Noemi M. Sigalove, Toni L. Storm-Dickerson, Nicole Pope, Jami Rice, G. Patrick Maxwell Are 30-Day Outcomes Enough? Late Infectious Readmissions following Prosthetic-Based Breast Reconstruction Willem Collier, Melody Scheefer Van Boerum, Jaewhan Kim, Alvin C. Kwok The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State Rose H. Fu, Onur Baser, Lu Li, Paul Kurlansky, Jessica Means, Christine H. Rohde Discussion: The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State Evan Matros, Meghana Shamsunder, Joseph J. Disa Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience Nicholas T. Haddock, Min-Jeong Cho, Sumeet S. Teotia Complications and Quality of Life following Reduction Mammaplasty in Adolescents and Young Women Laura C. Nuzzi, Joseph M. Firriolo, Carolyn M. Pike, Amy D. DiVasta, Brian I. Labow     Cosmetic         Original Articles   The Long-Term Static and Dynamic Effects of Surgical Release of the Tear Trough Ligament and Origins of the Orbicularis Oculi in Lower Eyelid Blepharoplasty Chin-Ho Wong, Bryan Mendelson The Probable Reasons for Dorsal Hump Problems following Let-Down/Push-Down Rhinoplasty and Solution Proposals Umut Tuncel, Oguzhan Aydogdu Discussion: The Probable Reasons for Dorsal Hump Problems following Let-Down/Push-Down Rhinoplasty and Solution Proposals Dean M. Toriumi Discussion: The Probable Reasons for Dorsal Hump Problems following Let-Down/Push-Down Rhinoplasty and Solution Proposals Sergey Y. Turin, Arun K. Gosain The Modified Sliding Alar Cartilage Flap: A Novel Way to Preserve the Internal Nasal Valve as Illustrated by Three-Dimensional Modeling Emmanuel Racy, Amanda Fanous, Thibaut Pressat-Laffouilhere, Nadia Benmoussa Efficacy of Botulinum Toxin in Treating Asian Indian Patients with Masseter Hypertrophy: A 4-Year Follow-Up Study Debraj Shome, Stuti Khare, Rinky Kapoor “Brazilian Butt Lift” Performed by Board-Certified Brazilian Plastic Surgeons: Reports of an Expert Opinion Survey Alvaro Luiz Cansancao, Alexandra Condé-Green, Rodrigo Gouvea Rosique, Marina Junqueira Rosique, André Cervantes   Ideas and Innovations   Gluteal Implant-Associated Anaplastic Large Cell Lymphoma José Mendes, Jr, Vinicius A. Mendes Maykeh, Luiz Fernando Frascino, Flavia F. S. Zacchi   Special Topic   Role of Fresh Frozen Cartilage in Revision Rhinoplasty Raja Mohan, R. Raja Shanmuga Krishnan, Rod J. Rohrich     Experimental       Adipose Stem Cells from Lipedema and Control Adipose Tissue Respond Differently to Adipogenic Stimulation In Vitro Anna-Theresa Bauer, Dominik von Lukowicz, Katrin Lossagk, Ursula Hopfner, Manuela Kirsch, Philipp Moog, Hannelore Bauer, Hans-Guenther Machens, Daniel Schmauss Cell-Enriched Fat Grafting Improves Graft Retention in a Porcine Model: A Dose-Response Study of Adipose-Derived Stem Cells versus Stromal Vascular Fraction Bo S. Rasmussen, Celine L. Sørensen, Sorel Kurbegovic, Mathias Ørholt, Maj-Lis M. Talman, Mikkel Herly, Christian B. Pipper, Stig-Frederik T. Kølle, Filip Rangatchew, Rikke Holmgaard, Peter V. Vester-Glowinski, Anne Fischer-Nielsen, Krzysztof T. Drzewiecki Correlations between Tracer Injection Sites and Lymphatic Pathways in the Leg: A Near-Infrared Fluorescence Lymphography Study Akira Shinaoka, Seijiro Koshimune, Kiyoshi Yamada, Kanae Kumagishi, Hiroo Suami, Yoshihiro Kimata, Aiji Ohtsuka Flap Blood Glucose as a Sensitive and Specific Indicator for Flap Venous Congestion: A Rodent Model Study Kana Mochizuki, Masato Mochizuki, Koichi Gonda Discussion: Flap Blood Glucose as a Sensitive and Specific Indicator for Flap Venous Congestion: A Rodent Model Study Giorgio Giatsidis Adipose-Derived Stem Cells and Ceiling Culture-Derived Preadipocytes Cultured from Subcutaneous Fat Tissue Differ in Their Epigenetic Characteristics and Osteogenic Potential Yoshitaro Sasahara, Yoshitaka Kubota, Kentaro Kosaka, Naoki Adachi, Yoshihisa Yamaji, Hidekazu Nagano, Shinsuke Akita, Masayuki Kuroda, Tomoaki Tanaka, Hideaki Bujo, Nobuyuki Mitsukawa Discussion: Adipose-Derived Stem Cells and Ceiling Culture-Derived Preadipocytes Cultured from Subcutaneous Fat Tissue Differ in Their Epigenetic Characteristics and Osteogenic Potential Mimi R. Borrelli, Michael T. Longaker, Derrick C. Wan   Hand/Peripheral Nerve         Original Articles   A Prospective Evaluation of Complications after Use of Exposed Pins in the Hand and Wrist Kevin F. Lutsky, David Edelman, Charles Leinberry, T. Robert Takei, Moody Kwok, Greg Gallant, Pedro Beredjiklian Extreme Thumb Losses: Reconstructive Strategies Francisco del Piñal Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain Carrie A. Kubiak, Stephen W. P. Kemp, Paul S. Cederna, Theodore A. Kung Discussion: Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain Kyle R. Eberlin   Ideas and Innovations   Replantation of Cryopreserved Fingers: An “Organ Banking” Breakthrough Zengtao Wang, Lei Zhu, Wei Kou, Wenhai Sun, Bo He, Chunxia Wang, Yun Shen, Yang Wang, Zhaowei Zhu, You Liang   Pediatric/Craniofacial         Original Articles   Absorbable Fixation Devices for Pediatric Craniomaxillofacial Trauma: A Systematic Review of the Literature Joseph Lopez, Nicholas Siegel, Alvaro Reategui, Muhammad Faateh, Paul N. Manson, Richard J. Redett Discussion: Absorbable Fixation Devices for Pediatric Craniomaxillofacial Trauma: A Systematic Review of the Literature Larry H. Hollier, Jr Outcomes and Complications of Pediatric Cranioplasty: A Systematic Review Amjed Abu-Ghname, Joseph Banuelos, Jeremie D. Oliver, Krishna Vyas, David Daniels, Basel Sharaf Discussion: Outcomes and Complications of Pediatric Cranioplasty: A Systematic Review Richard A. Hopper Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review Katelyn G. Bennett, Alexis D. Vick, Russell E. Ettinger, Steven M. Archer, Christian J. Vercler, Steven R. Buchman Discussion: Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review Jeffrey A. Fearon   Ideas and Innovations   Serial Visual Evoked Potentials in Patients with Craniosynostosis and Invasive Intracranial Pressure Monitoring Mostafa M. Haredy, Alki Liasis, Valeria Fu, Amani Davis, Ian F. Pollack, Joseph E. Losee, Samia Saied, Ken K. Nischal, Jesse A. Goldstein Airway Analysis in Apert Syndrome Antonio J. Forte, Xiaona Lu, Peter W. Hashim, Derek M. Steinbacher, Michael Alperovich, John A. Persing, Nivaldo Alonso Discussion: Airway Analysis in Apert Syndrome Srinivas Susarla, Richard A. Hopper, Ezgi Mercan   Video+   Correction of Sagittal Synostosis Using Three-Dimensional Planning and Maltese Cross Geometry Anamika Veeramani, Anusha Singh, Michael L. DiLuna, Derek M. Steinbacher Discussion: Correction of Sagittal Synostosis Using Three-Dimensional Planning and Maltese Cross Geometry Larry H. Hollier, Jr   Reconstructive         Head and Neck: Original Articles   Ear Reconstruction after Mohs Cancer Excision: Lessons Learned from 327 Consecutive Cases Kyle Sanniec, Muhammad Harirah, James F. Thornton The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes Saja S. Scherer, Luigi Schiraldi, Gianluca Sapino, Janos Cambiaso-Daniel, Alessandro Gualdi, Ziv M. Peled, Robert Hagan, Giorgio Pietramaggiori Reconstruction of Posterior Mandibulectomy Defects in the Modern Era of Virtual Planning and Three-Dimensional Modeling Edward I. Chang, Stefanos Boukovalas, Jun Liu, Rene D. Largo, Matthew M. Hanasono, Patrick B. Garvey   Trunk: Special Topic   Surgical Treatment of Lymphedema Mark V. Schaverien, Christopher J. Coroneos   Lower Extremity: Original Articles   Timing of Microsurgical Reconstruction in Lower Extremity Trauma: An Update of the Godina Paradigm Z-Hye Lee, John T. Stranix, William J. Rifkin, David A. Daar, Lavinia Anzai, Daniel J. Ceradini, Vishal Thanik, Pierre B. Saadeh, Jamie P. Levine Discussion: Timing of Microsurgical Reconstruction in Lower Extremity Trauma: An Update of the Godina Paradigm L. Scott Levin Volumetric Analysis in Autologous Fat Grafting to the Foot Edward J. Ruane, Danielle M. Minteer, Aaron J. Wyse, Beth R. Gusenoff, Jeffrey A. Gusenoff   CME       Safety and Adjuncts in Face Lifting Dinah Wan, Erez Dayan, Rod J. Rohrich   Plastic Surgery Focus         Special Topics   Social Media: Is the Message Reaching the Plastic Surgery Audience? Austin D. Chen, Qing Zhao Ruan, Alexandra Bucknor, Anmol S. Chattha, Patrick P. Bletsis, Heather J. Furnas, Bernard T. Lee, Samuel J. Lin Evaluating the Economic Impact of Plastic and Reconstructive Surgical Efforts in the Developing World: The ReSurge Experience Jacob S. Nasser, Jessica I. Billig, Gloria R. Sue, James Chang, Arun K. Gosain, Kevin C. Chung Discussion: Evaluating the Economic Impact of Plastic and Reconstructive Surgical Efforts in the Developing World: The ReSurge Experience Larry H. Hollier, Jr Local Anesthetic Systemic Toxicity: A Narrative Literature Review and Clinical Update on Prevention, Diagnosis, and Management Marina Gitman, Michael R. Fettiplace, Guy L. Weinberg, Joseph M. Neal, Michael J. Barrington Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review Jad Abi-Rafeh, Dino Zammit, Mehrad Mojtahed Jaberi, Becher Al-Halabi, Stephanie Thibaudeau   Book and Media Reviews       Global Reconstructive Surgery Donald R. Mackay Grabb’s Encyclopedia of Flaps. Fourth Edition Rachita Sood, Sumanas W. Jordan   Letters       Hybrid Prepectoral Breast Reconstruction: A Surgical Approach that Combines the Benefits of Autologous and Implant-Based Reconstruction Shangshan Li, Jie Luan Reply: Hybrid Prepectoral Breast Reconstruction: A Surgical Approach that Combines the Benefits of Autologous and Implant-Based Reconstruction Arash Momeni, Suhail Kanchwala The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines: A Randomized Controlled Trial and an Algorithmic Approach to Forehead Injection Zhen Zhai, Zuoliang Qi Reply: The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines: A Randomized Controlled Trial and an Algorithmic Approach to Forehead Injection Samer Jabbour, Elio Kechichian, Marwan Nasr Fate of Free Fat Grafts with or without Adipogenic Adjuncts to Enhance Graft Outcomes Shengyang Jin, Facheng Li Reply: Fate of Free Fat Grafts with or without Adipogenic Adjuncts to Enhance Graft Outcomes Jason A. Palmer Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy Malke Asaad, Krishna Vyas, Margaret Akinhanmi, Joyce E. Balls-Berry Reply: Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy Jessica I. Billig, Kevin C. Chung Clockwise and Counterclockwise Le Fort I Movements Influence Nasolabial Morphology Differently Chenzhi Lai, Qi Pan, Xiaolei Jin Reply: Clockwise and Counterclockwise Le Fort I Movements Influence Nasolabial Morphology Differently Derek M. Steinbacher Salvaging the Unavoidable: A Review of Complications in Pediatric Tissue Expansion Miguel Angel Gaxiola-García, Angel Puente Sánchez Reply: Salvaging the Unavoidable: A Review of Complications in Pediatric Tissue Expansion Sergey Y. Turin, Arun K. Gosain Hering’s Law of the Frontal Facial Branch Fernando Procianoy Reply: Hering’s Law of the Frontal Facial Branch Haydar Aslan Gülbitti, Berend van der Lei Current Basal and Squamous Cell Skin Cancer Management Sameer Massand, Rogerio I. Neves Reply: Current Basal and Squamous Cell Skin Cancer Management Bernardino M. Mendez, James F. Thornton Ethics in Plastic Surgery: Applying the Four Common Principles to Practice Thomas Hampton, Shakeel Rahman Reply: Ethics in Plastic Surgery: Applying the Four Common Principles to Practice Lucas Gallo, Charmaine Baxter, Jessica Murphy, Lisa Schwartz, Achilleas Thoma   Viewpoints       Prepectoral Breast Reconstruction: A Growth Story Tyler Safran, Becher Al-Halabi, Tassos Dionisopoulos Using “1-2-3 Rule” for Locating the Internal Mammary Vessels in Smaller Size Population Apinut Wongkietkachorn, Palakorn Surakunprapha, Waraporn Sakaew, Tawut Rudtanatip, Nuttapone Wongkietkachorn, Supawich Wongkietkachorn A Novel Periareolar Approach to Chest Wall Reconstruction Using a Nipple-Areola Complex Transposition Flap Jordan D. Frey, Catherine C. Motosko, Kevin Moore, Grace Poudrier, Alexes Hazen The Open Payments Database and Top Industry Sponsors of Plastic Surgeons: Companies and Related Devices Samuel R. Boas, Joshua D. Niforatos, Lesley Summerville, Kelsey Isbester, Anil Chaturvedi, Corinne Wee, Anand R. Kumar Ethics Education in Plastic Surgery Training Programs J. Randall Patrinely, Jr, Brian C. Drolet, Galen Perdikis, Jeffrey Janis Dogma Rounds: Challenging the Status Quo Alexander Morzycki, Kevin Nickel, Jay Zhu Shaming and Burnout in Plastic Surgery Trainees: An Underappreciated Problem? Srinivas M. Susarla, Jeffrey B. Friedrich   Announcements       ASPS/PSF Sponsored Symposia and Workshops International Meetings and Symposia

Breast Article: Focus of Live Facebook #PRSJournalClub Q&A
Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction?

Hand Article Featuring a Plastic Surgery Hot Topic Video
Replantation of Cryopreserved Fingers: An Organ Banking Breakthrough

Reconstructive Article Featuring an Expert Discussion
Timing of Microsurgical Reconstruction in Lower Extremity Trauma: An Update of the Godina Paradigm

Cosmetic Article: Editor’s Pick 
The Long-Term Static and Dynamic Effects of Surgical Release of the Tear Trough Ligament and Origins of the Orbicularis Oculi in Lower Eyelid Blepharoplasty

Experimental Article Featuring a Video Discussion
Cell-Enriched Fat Grafting Improves Graft Retention in a Porcine Model: A Dose-Response Study of Adipose-Derived Stem Cells versus Stromal Vascular Fraction

Plastic Surgery Focus
Social Media: Is the Message Reaching the Plastic Surgery Audience?

Patient Safety Articles

• Breast: Complications and Quality of Life Following Reduction Mammaplasty in Adolescents and Young Women
• Hand: A Prospective Evaluation of Complications after Use of Exposed Pins in the Hand and Wrist
• CME: Safety and Adjuncts in Face Lifting