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Background:. Gender-affirming mastectomy (GAM) is a gender-affirmation surgery designed to remove or reduce breast tissue, with or without nipple reconstruction. GAM is the most commonly performed gender-affirmation surgery and risk factors associated with unplanned return to the operating room and reoperation continue to be investigated. This is the largest study of transgender and nonbinary patients undergoing GAM to determine predictors of unplanned reoperation. Methods:. The National Surgical Quality Improvement Program database was queried for patients undergoing GAM from 2012 to 2020. The primary outcome was the incidence of unplanned reoperation within 30 days postoperatively. The secondary outcome was the indication for unplanned reoperation within this period. Descriptive statistics were calculated. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of reoperation after GAM. Results:. A total of 2316 patients underwent GAM, of whom 2.2% (n = 51) underwent unplanned reoperation of the chest. The most common indication for unplanned reoperation was hematoma (n = 41, 71.9%) followed by abscess (n = 5, 8.8%). Significant predictors of reoperation were corticosteroid use [adjusted odds ratio (aOR) 95% confidence interval (CI) 5.07 (1.07–23.89)] and diabetes [aOR (CI) 10.98 (3.0–40.33)]. Hispanic/Latinx ethnicity [aOR (CI) 3.19 (1.22–8.33)] and corticosteroid use [aOR (CI) 6.81 (1.45–31.98)] were significant predictors of unplanned reoperation for hematoma evacuation after GAM. Conclusions:. Diabetes mellitus and corticosteroid use were associated with unplanned reoperation after GAM. Ethnic correlations remain to be better elucidated as well as the effect of intersectionality. These findings can be used to guide patient selection and surgical decision-making.

Background:. There is a paucity of patient-reported outcome measures for facial trauma reconstruction. To measure satisfaction and health-related quality of life (HRQOL), following repair of traumatic facial fractures, we used the FACE-Q, a set of patient-reported outcome instruments designed for aesthetic facial surgery. As a step toward validating the scales for facial trauma, we evaluated their reliability. Methods:. This is a prospective study of patients following primary repair of traumatic facial fractures at a level 1 trauma center from 2016 to 2018. Six FACE-Q scales with relevance to the facial trauma population were completed by patients at their 1-month postoperative visits. Predictors of satisfaction were examined using multiple linear regression models. Reliability of the scales in this population was evaluated using psychometric methods. Results:. One hundred eighty-five participants fulfilled inclusion criteria. Mean scores for the 6 scales ranged from 59 (SD = 15) for Recovery-Early Life Impact to 94 (SD = 13) for Satisfaction with Medical Team. Predictors of lower satisfaction and/or HRQOL include current tobacco smoking status, mandibulomaxillary fixation, and Le Fort pattern fractures. All scales were found to have good to excellent reliability (Cronbach’s alpha = 0.824–0.969). Conclusions:. Following repair of facial fractures, patient-reported outcomes can be reliably measured using FACE-Q scales. On average, patients report poor health-related quality of life in the early postoperative period. Predictors of low satisfaction and/or poor HRQOL include current smoking habit, mandibulomaxillary fixation, and Le Fort fractures.

Background: The purpose of this study is to assess which personal characteristics and external factors are important contributors to eventual success. Methods: The authors distributed a survey to all members of the American Association of Plastic Surgeons and asked responders to rate the importance of 10 preselected qualities in contributing to their personal success. Survey outcomes were analyzed across different demographic groups. Results: Of the 580 American Association of Plastic Surgeons members who were surveyed, 295 returned completed surveys. Overall analysis indicates that hard work, compassion, and manual dexterity are the 3 most important attributes. Many significant differences are observed across demographic groups, indicating potential biases among the survey responders. Notably, we find that male surgeons attribute mentorship to success much more so than female surgeons (Column Trend Exact [CTE], P = 0.021), whereas female surgeons are more likely to attribute their success to hard work (CTE, P = 0.023). Similarly, those who have been program directors credit their success to mentoring more so than nonprogram directors (CTE, P < 0.00001). The authors also found that senior surgeons, as measured by years in practice, place greater emphasis on mentoring and career opportunities than younger surgeons (Mantel-Haenszel Trend, P = 0.003 and 0.0009, respectively). It is also interesting to note that individual talent qualities tend to be favored by more senior surgeons and those with more distant ties to academia. Conclusion: The authors believe that recognizing the relative importance of such factors, and their associated biases, is essential for the process of selecting and developing future successful plastic surgeons.