Summary: Physicians attempted to continue providing patient care through the SARS-CoV2 (COVID-19) pandemic. Surgeons embraced telemedicine as patient evaluation transitioned from physical encounters to virtual appointments. However, there is a paucity in the literature on the utility of telemedicine within plastic surgery or how it can meet patients’ needs. A survey study was created to assess surgeons’ involvement and experience with telemedicine. Subjective experience was assessed on a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). This survey was distributed to the members of the American Society of Plastic Surgeons. Data were collected and analyzed via RedCap. Of the total 177 plastic surgeons who responded, 139 (78.5%) surgeons reported the implementation of telemedicine during the pandemic. Plastic surgeons felt that they were able to establish rapport (3.9 ± 0.9), meet the goals of the encounter (3.6 ± 1.0), and efficiently evaluate patients (3.5 ± 1.2). Plastic surgeons reported their overall experience was between helpful and neutral (3.2 ± 1.3). Most plastic surgeons have implemented telemedicine in their practice. The majority of telemedicine use was for breast, cosmetic, and reconstructive patient care. Telemedicine was most frequently used for initial patient screening and routine postoperative visits. Surgeons plan to continue using telemedicine when appropriate for patient screening and routine or unexpected postoperative visits in the future. Many have found utility of telemedicine in providing patient care and it is likely that telemedicine will be a part of routine practice moving forward.

Introduction: The use of an inferiorly based dermal flap (IBDF) with implant insertion allows for 1-step reconstruction of a ptotic breast after mastectomy. An IBDF allows for secondary protection of the inferior pole and provides a vascularized pocket for implant insertion. Previous literature has demonstrated the use of this surgical approach for optimal patient satisfaction and higher patient-reported outcomes. For this approach, the dermal flap epidermis is removed before insetting; however, invaginations containing epithelial components may serve as a nidus for infection. There is no study that has compared the safety of an IBDF technique to standard reconstruction. We hypothesize that there is no increase in surgical complications in the IBDF approach versus standard reconstruction. Methods: This is a single-institution retrospective chart review of all patients who underwent implant-based reconstruction from June 2016 through December 2020. Patients who did not have a permanent implant placed by December 2020 or had delayed reconstruction were excluded. Two cohorts were established: those who underwent immediate reconstruction after mastectomy via IBDF and reconstruction without an IBDF. Patient demographics, use of the IBDF technique, and surgical complications were recorded and compared. Results: A total of 208 breasts were included: 52 breasts in the IBDF cohort and 156 breasts in the control cohort. There were no statistically significant differences between cohorts, except that the IBDF cohort has a significantly higher body mass index (mean = 30.9 vs 26.5, P ≤ .001). There was no statistically significant difference in the rate of complications between the IBDF and control groups, including seroma (5.8% vs 3.8%), hematoma (3.8% vs 0.6%), wound dehiscence (0.0% vs. 1.9%), mastectomy flap necrosis (11.5% vs 6.4%), breast infection (5.8% vs 7.1%), implant salvage (0.0% vs 5.8%), and implant loss (5.8% vs. 5.8%), respectively. Conclusions: Using an IBDF to reconstruct a ptotic breast immediately after mastectomy has a similar risk profile to an immediate standard breast reconstruction. This technique has resulted in optimal patient satisfaction scores and allows for a “one-stop reconstruction” of ptotic breasts that normally would undergo sequential revisions. In conclusion, immediate implant-based reconstruction of a ptotic breast after mastectomy using a IBDF can be performed safely.

Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures—one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons.

Background and Objectives: Facial gender-confirmation surgery (FGCS) has expanded rapidly but remains uneven across procedures, specialties, and outcome domains, limiting clinically useful interpretation for surgeons. The aim is to characterize how FGCS evidence has developed and to identify gaps relevant to surgical reporting and patient-centered outcome evaluation. Materials and Methods: Systematic searches were conducted without date restriction in PubMed, Scopus, Web of Science, LiLACS, and EBSCOhost through June 2025. Eligible studies included original clinical research, systematic reviews (SR), technical notes, and economic evaluations. Two reviewers independently screened and extracted data. PROSPERO: CRD420251041192. Results: Among 338 included studies, the literature was concentrated on feminization procedures (78%) and hard-tissue interventions (51%). Outcome reporting was dominated by surgical technique (36%) and complications (29%); patient-centered domains were less represented, including satisfaction (25%), preferences (7%), recovery (2%), and ethics (3%). Masculinization and soft-tissue procedures were less frequently studied. Methodological quality of the 36 included SRs was predominantly critically low (72%) or low (28%). Conclusions: Procedural reporting in FGCS has developed asymmetrically relative to standardized patient-centered outcome measurement, a pattern consistent with the formative stages observed in other surgical fields. For surgeons, this limits comparability across procedures and weakens the evidence base for counseling, multidisciplinary planning, and postoperative evaluation. Future research should prioritize more consistent and validated patient-reporting frameworks.

We present a case of an adolescent who sustained multiple facial fractures following a high-speed, head-on skiing collision. The patient presented to a level 1 trauma centre with bilateral LeFort I, LeFort II, naso-orbital ethmoid fractures and superior maxillary displacement to the level of the orbits requiring a staged operative approach to (1) disimpact the maxillary LeFort I segment and (2) reduce and fixate the multilevel facial fractures. The patient was discharged home with close follow-up, and after 1 year, had preservation of appropriate facial proportions without complications. This case study focuses on the triage, management and surgical planning of paediatric midface fractures, which are relatively uncommon to treat. Special considerations for repairing facial fractures in adolescents are discussed.