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Background: Medical training is known to impose financial burden on trainees, which has been shown to contribute to burnout, even possibly compromising patient care. Financial literacy allows for management of financial situations affecting professional and personal life. The authors aimed to evaluate the financial status and knowledge among plastic surgery residents., Methods: A survey regarding finances and financial literacy of plastic surgery residents was sent to all the current accredited U.S. residency programs. The same survey was distributed internally. A descriptive analysis was performed, and multiple Fisher exact tests and a t test evaluated comparisons., Results: Eighty-six residents were included. Most trainees had a student loan (59.3%), with 22.1% having loans more than $300,000. A majority had at least one personal loan debt other than educational (51.1%). Residents with more debt were significantly less likely to pay off their balances monthly. A total of 17.4% of trainees had no plan for how to invest their retirement savings, whereas 55.8% reported not knowing how much they need to save to retire. One in five trainees did not feel prepared to manage personal finances/retirement planning after graduation, a majority had no formal personal finance education in their curriculum, and 89.5% agreed that financial literacy education would be beneficial. Our institutional data largely mirrored national data., Conclusions: Many residents are lacking in financial knowledge, despite most having significant debt. Additional financial literacy education is needed in plastic surgery training. Curricula development at an institutional or national society level are possible paths toward a coordinated response to this need., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Summary: Ventral hernias have numerous causes, ranging from sequelae of surgical procedures to congenital deformities. Patients suffering from these hernias experience a reduced quality of life through pain, associated complications, and physical disfigurement. Therefore, it is important to provide these patients with a steadfast repair that restores functionality and native anatomy. To do this, techniques and materials for abdominal wall reconstruction have advanced throughout the decades, leading to durable surgical repairs. At the cornerstone of this lies the use of mesh. When providing abdominal wall reconstruction, a surgeon must make many decisions with regard to mesh use. Along with the type of mesh and plane of placement of mesh, a surgeon must decide on the method of mesh fixation. Fixation of mesh provides an equal distribution of tension and a more robust tissue-mesh interface, which promotes integration. There exist numerous modalities for mesh fixation, each with its own benefits and drawbacks. This Special Topic article aims to compare and contrast methods of mesh fixation in terms of strength of fixation, clinical outcomes, and cost-effectiveness. Methods included in this review are suture, tack, fibrin glue, mesh strip, and self-adhering modes of fixation., (Copyright © 2020 by the American Society of Plastic Surgeons.)

Synthetic mesh is commonly used in ventral hernia repairs to reinforce the abdominal closure and minimize hernia recurrence rates. However, the use of synthetic mesh is associated with certain risks, most notably infection requiring explantation. This study sought to evaluate the use of a "no-touch" technique with antibiotic solution during synthetic mesh placement in ventral hernia repairs and its impact on complication/infection rates. The authors retrospectively reviewed a prospectively maintained database of patients undergoing abdominal wall reconstruction with synthetic mesh from 2013 to 2018 by a single surgeon with a minimum 1-year follow-up. Data collected included demographic data, medical comorbidities, hernia history, and the type of antibiotics used in the no-touch technique. Complications were stratified into short-term (<30 days), medium-term (30 to 90 days), and long-term (91 to 365 days) complications. Results were compared to previously published rates in the literature. Eighty-eight patients met inclusion criteria. Fourteen patients (15.9 percent) experienced postoperative complications (two patients had multiple complications); six of these patients (6.8 percent) were readmitted to the hospital for management. Subsequently, three of the readmitted patients (3.4 percent) required reoperations related to abdominal infection and required removal of the synthetic mesh. A total of 16 complication events occurred in the cohort: 13 short-term complications (81.3 percent), three medium-term complications (18.7 percent), and zero long-term complications. The authors conclude that the no-touch technique for mesh placement in ventral hernia repairs appears to be efficacious in minimizing infectious complications with mesh placement, although further prospective studies are required to further define this relationship. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Background: Ventral hernias are a common problem after exploratory laparotomy, and plastic surgeons often become involved for hernia repair in complex situations. Plastic surgeons can achieve fascial closure through primary repair, an external oblique aponeurosis release, or a transversus abdominis release. Currently, there is scant literature evaluating venous thromboembolism rates after these procedures. The authors sought to evaluate their own experience with complex abdominal wall reconstruction and venous thromboembolism events., Methods: The authors retrospectively reviewed their prospectively collected database of all patients who have undergone complex abdominal wall reconstruction performed by a single surgeon at their institution from September of 2013 to February of 2018. Demographic data, anticoagulant use, Caprini score, operative time, and postoperative venous thromboembolism events were recorded. A literature search was also performed, identifying all published articles evaluating venous thromboembolism events after abdominal wall reconstruction., Results: The authors identified 175 patients for analysis. Four patients were found to have postoperative venous thromboembolism events, for a total venous thromboembolism rate of 2.3 percent. The average Caprini score for these patients was 8.5, compared to 5.26 for those without a venous thromboembolism event, and no deaths were reported from these complications. On literature review, three articles were identified in the literature discussing venous thromboembolism after abdominal wall reconstruction, all based on the American College of Surgeons National Surgical Quality Improvement Program database., Conclusions: Patients undergoing complex abdominal wall reconstruction are at high risk for venous thromboembolism events. There is scant literature published on this topic, but surgeons should be aware of the risk for venous thromboembolism after complex abdominal wall reconstruction and work to minimize this risk as much as possible., Clinical Question/level of Evidence: Therapeutic, IV.

The inframammary fold presents a reconstructive challenge once disrupted during total mastectomy or inadequately restored during breast reconstruction. Various methods of recreating the inframammary fold have been proposed, but reports are generally based on small sample sizes and lack long-term analyses and patient-reported outcomes. The authors herein review the literature on inframammary fold anatomy and reconstructive techniques, highlighting the need for more critical analysis of methodology to develop more predictable and durable outcomes.

Background: Recent studies suggest that the decisions to undergo breast reconstruction and contralateral prophylactic mastectomy are closely related. In this article, the relationship between method of reconstruction and decision to undergo contralateral prophylactic mastectomy is described. Recent trends in contralateral use in the context of literature questioning its oncologic benefit are also evaluated., Methods: Female patients with unilateral breast cancer were identified and data extracted from the Surveillance, Epidemiology, and End Results database from 2000 through 2010. Logistic regression analyses were performed to study the relationship between having contralateral prophylactic mastectomy and key demographic, oncologic, and reconstructive factors among women with unilateral breast cancer., Results: A total of 157,042 patients with unilateral breast cancer were included. The contralateral prophylactic mastectomy rate increased from 7.7 percent to 28.3 percent during the study period, and the proportion of reconstructed patients who underwent contralateral prophylactic mastectomy increased from 19 percent to 46 percent. Reconstruction was associated with higher odds of contralateral prophylactic mastectomy (OR, 2.79; 95 percent CI, 2.70 to 2.88; p < 0.0001). Among women who had reconstruction, implant-based reconstruction was associated with significantly higher odds of contralateral prophylactic mastectomy than autologous tissue reconstruction (OR, 1.38; p < 0.0001)., Conclusions: This study confirms that reconstruction and the decision to undergo contralateral prophylactic mastectomy are closely related, with implant reconstruction dominating in these patients. Given the close relationship between reconstruction and the choice for contralateral prophylactic mastectomy, plastic surgeons should play an active role in educating patients to avoid decisions made based on inaccurate information., Clinical Question/level of Evidence: Risk, II.