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Background: Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique., Methods: We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate., Results: 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: None. Ethical Approval: This case report conforms to the Declaration of Helsinki, (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background Plastic surgery is a dynamic field within medicine, shaped by various factors that impact medical students' perceptions and career choices. This study aimed to assess medical students' perceptions of plastic surgery as a specialty career and to examine factors influencing it, particularly understanding the impact of demographics, educational exposure, and media. Methods A cross-sectional study involved 777 medical students from diverse universities across Saudi Arabia. Students from both public and private medical colleges participated by completing an online questionnaire detailing their perceptions, exposure to plastic surgery, and career interests. Chi-square tests were used for the comparative analysis. Results The majority of participants were females, 64.2% (499 of 777), and only a small fraction expressed a strong interest in pursuing plastic surgery as a specialty, 10.9% (85 of 777), with social media and the internet emerging as influential sources of information. A majority of the students, 71.7% (557 of 777), acknowledged the impact of medical dramas on their career choice, while 42.3% (329 of 777) admitted to infrequently researching the topic online. Interestingly, while overall interest in plastic surgery was modest, preferences varied across clinical scenarios, with orthopedics and neurology/neurosurgery also receiving consideration. Academic performance, as measured by grade point average (GPA), did not significantly correlate with students' perceptions of plastic surgery. However, among female students, watching medical dramas was a significant influencing factor with a p-value of 0.001. Conclusion The findings highlight the complexity of factors influencing medical students' views on plastic surgery, stressing the need for focused educational efforts and mentorship initiatives. Early intervention to correct misconceptions and increase exposure to the specialty during medical training is crucial for cultivating interest and developing a knowledgeable workforce in plastic surgery., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board, General Directorate of Health Affairs in Madinah issued approval 022-72. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alsubhi et al.)

Celiac disease is an autoimmune disease that occurs due to gluten intolerance. The prevalence of breast cancer among celiac disease patients is the same as in the general population. It is of note that breast cancer is the most common type of cancer in women. Following mastectomy, these patients visit plastic surgeons for breast reconstruction. Based on various factors, autologous reconstruction using abdominal-based flaps is the best option. Patients with celiac disease have a high incidence of thromboembolic disorders, which may prevent plastic surgeons from doing breast reconstruction with free flaps. We present a case of a patient with celiac disease who underwent a free flap for breast reconstruction with an uneventful course after using our routine postoperative protocol. This case report highlights that patients with celiac disease cannot be denied the option of breast reconstruction with free flaps., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)