The practice of plastic surgery has become more complex. As plastic surgeons face the postgraduate realities of contracts, negotiations, and health system employment, they are frequently unprepared to effectively manage these challenges. Furthermore, many plastic surgery training programs do not emphasize real-world business and policy concerns in residency training.

With this ongoing series of special topics, guest edited by Edward M. Reece, M.D., M.B.A. and Neil Tanna, M.D., M.B.A.,Plastic and Reconstructive Surgery endeavors to provide robust conceptual education and guidance in business and policy to help both private practice and academic plastic surgeons participate in, lead, and shape the future of health care.

Stay tuned: more entires in this series will be published regularly

The Outcomes Article Collection was created to educate plastic surgeons on the expanding role of outcomes research in the field of plastic and reconstructive surgery. This form of research explores numerous aspects of healthcare including the broad outcomes categories of prevention (safety studies, systematic reviews), quality of care, patient reported health, and life and healthcare costs.

As we enter into the realm of value based care, it has become evident that a significant portion of U.S. healthcare spending is for services with blurred clinical effectiveness. Practice patterns span different specialties, and communities differ, making it more difficult to discern the links between the types of care being delivered and the outcome reached. Another issue is the deficiency of an evidenced-based understanding into what management choices may be most appropriate for various patient populations.

In the current healthcare environment, outcomes research drives decision-making and has implications on policy as well as influencing contemporary practice trends. Furthermore, it provides a significant perspective on how care is measured and delivered through an inclusive approach that respects patient preferences. Ultimately, if significant improvements can be made, adjustments can be shared with others to implement.

This is the core of healthcare reform and value-based care; achieving greater outcomes, and refining patient health, swiftly and competently. In general, these articles have outperformed other journal topics, again emphasizing their importance. It is the responsibility of the Journal to ensure that outcomes research is presented in a standardized fashion that is easily understandable. This collection will hopefully allow readers to make informed decisions regarding healthcare.

Samuel J. Lin, MD

Outcomes Consulting Editor- Plastic and Reconstructive Surgery

COVID-19 is a quickly changing, growing global situation. Read the latest viewpoints, editorials, and scientific studies about the COVID-19 pandemic from plastic surgery community here in Plastic and Reconstructive Surgery. Many of these manuscripts are published as "accepted-manuscript" versions only, in order to present the findings to you as quickly as possible. We hope you find these articles informative and meaningful. More articles on the topic of COVID-19 will be published here as they are accepted. Submit your own studies to PRS and PRS Global Open today.

About "Accepted-version" publications: These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue. As these PRS "Online First" manuscripts represent raw, pre-production files, please note that they will not include any of the mentioned Supplemental Digital Content. Articles appearing as "Accepted-Manuscript" versions have been peer-reviewed and accepted for publication in this journal and posted online before final publication. Articles appearing here may contain statements, opinions, and information that have errors in facts, figures, or interpretation. Accordingly, the American Society of Plastic Surgeons, Wolters Kluwer, the editors and authors and their respective employees are not responsible or liable for the use of any such inaccurate or misleading data, opinion or information contained the articles in this section.

This collection has won the following publishing awards:

2021 Folio: Eddie and Ozzie Award Honorable Mention for Best Series of Articles

2022 APEX Award of Excellence for Health & Medical Covid-19 Media

American Society of Plastic Surgeons clinical practice guidelines and performance measures are developed using internationally recognized methodologies for evidence-based processes, which include a systematic review of the evidence to support guidelines (and guidelines in turn support performance measures). Both products are developed with multi-disciplinary work groups that include relevant stakeholders and patients whenever possible, a rigorous peer review and public comment process, and require formal approval and adoption by the ASPS Quality and Performance Measurement Committee and Executive Committee.

Learn more:

• ASPS Guideline Process
• ASPS Measures Process

This collection of Plastic and Reconstructive Surgery articles spanning January 2019 to June 2021 represents the “best of the best" in the breast plastic surgery literature.  The articles have been chosen to cover hot topics relevant to practicing plastic surgeons, and each offers a unique contribution to the literature. 

Highlights from the series include articles helping to define breast aesthetics, trial new technology, to assess long-term clinical and patient-reported outcomes, and address the opioid epidemic. Pietruski et. al use eye-tracking technology to identify the nipple-areolar complex and lower breast as key focus areas for breast attractiveness.¹  To assess the outcomes between prepectoral and subpectoral breast reconstruction with acellular dermal matrix, Momeni et. al perform a matched study and show no difference in complication rates.²  Controversy remains regarding optimal choices for patients in breast reconstruction.  In a retrospective comparative study, Schaverien et. al determine volume-replacement oncoplastic breast surgery has fewer procedures, complications, and time commitment compared to mastectomy and total breast reconstruction in their series.

The Mastectomy Reconstruction Outcomes Consortium (MROC) study prospectively gathered information on breast reconstruction outcomes to help address ongoing debates.  For patients requiring post-mastectomy radiotherapy, questions remain on whether radiation should be delivered to the tissue expander or permanent implant.  Yoon et al. show a similar rate of complications with radiation to either device⁴.  To help counsel patients on revisional breast surgery, Nelson et. al report 40% of breast reconstruction patients undergo elective revisions.

Further controversy arises on whether contralateral prophylactic mastectomy should be performed at the time of therapeutic mastectomy.  In their paper, Sharabi et. al show a low risk of complications in contralateral mastectomy and few delays to adjuvant treatment. For implant reconstructions that do fail, an analysis by Corridi et. al suggests that autologous reconstruction can provide a significant improvement in satisfaction with the breasts and quality of life.

The opioid epidemic has been linked to opioid prescribing practices.  In their paper, Egan et. al show that breast reconstruction patients on average take only 57% of the prescribed pills, suggesting that practice guidelines may be changed to prescribe fewer opioids.

In review of the papers from the past 30 months, perhaps the most astonishing finding was the consistent and high-level of quality of all the papers published in Plastic and Reconstructive Surgery.  While this collection captures a group of excellent scientific discoveries, it by no means is meant to take away from the rest.   We encourage the reader to review all the articles published in this time frame for the most up-to-date plastic surgery literature. 

Amy S. Colwell, M.D. and Joseph J. Disa, M.D.

This Special Collection- and the Printed Edition that accompanies it- was made possible by a sponsorship from Mentor Worldwide LLC (Platinum Sponsor), Baxter_Synovis (Platinum Sponsor), MTF Biologics (Gold Sponsor), Sientra Inc. (Silver Sponsor).

Plastic and Reconstructive Surgery presents a dynamic, peer-reviewed Masters Series of video vignettes and articles. The video vignettes, each approximately 2 to 3 minutes in length, contain the key surgical and technical elements to obtain consistent results in a variety of plastic surgery procedures, demonstrated by the innovators or masters in these areas.

Each Masters Series video vignette article is accompanied by approximately 10 bullet points summarizing the key elements in treatment planning and technical execution, as well as a list of classic references. These very compact, thorough, and educational vignettes will allow for rapid reference of procedures done by masters in plastic surgery.

The first video vignettes in this series appear in PRS’ Cosmetic section, featuring videos from the Baker Gordon Symposium.

We hope you enjoy this new addition to Plastic and Reconstructive Surgery as we enter a new era in medical publishing: immediately usable, technique-based, peer-reviewed, educational videos and short articles. Our hope is that the PRS Video Vignette Masters Series will inspire others to submit their short, high-quality videos to all sections of the Journal, and that readers will be able to take the educational techniques into clinical and operative consideration.

Rod J Rohrich, MD

PRS Editor-in-Chief

James M Stuzin, MD

PRS- Co-Editor

We stand with, and in full support of, our Black colleagues, in hopes of creating a plastic surgery workforce more reflective of the diverse patient population which we are honored to treat. Improving equity in provision of care, research pursuits, and the education of the next generation of plastic and reconstructive surgeons is dependent on it. We are pleased that the below articles have been set free through March 15th, so all can read and share.

And for those of you who are interested in more articles, please read our special, open access Black History Month article collection in PRS Global Open!

Sincerely,

Paris D. Butler, MD, MPH, FACS- Chair, Diversity Committee of American Society of Plastic Surgery (ASPS)

Steven H. Williams, MD- Section Editor - Technology, PRS Global Open

Rod J. Rohrich, MD- Editor-in-Chief, Plastic and Reconstructive Surgery

Psychosocial Insights columns provide psychological commentary from PRS Consulting Editor, Dr. David B. Sarwer.

Sarwer is Associate Dean for Research, Professor of Social and Behavioral Sciences, and Director of the Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pa.

This Feature won the 2018 Bronze Award for "Best New Department" from the "American Society of Healthcare Publication Editors.

In this era of enhanced patient safety and outcomes and increased scrutiny of medical devices, the safety of breast implants in both aesthetic and reconstructive surgery has yet again become a topic in the spotlight. Breast augmentation is one of the most popular aesthetic procedures performed and implant-based breast reconstruction represents ~80% of all breast reconstructions. It is important for surgeons to have access to the data regarding these devices. This PRS Collection contains scholarly articles published in Plastic and Reconstructive Surgery addressing this topic. Implant safety, longevity, complications and patient outcomes are addressed.

This robust collection highlights the science behind breast implant safety, and was compiled by Breast Section Editor, Joseph Disa, MD.

For further reading on this topic:

- Safety of Silicone Breast Implants. Institute of Medicine (US) Committee on the Safety of Silicone Breast Implants

- Silicone Gel Breast Implants: What We Know About Safety After All These Years. Ann Intern Med. 2016 Feb 2;164(3):199-200.

- Lactation Outcomes in More Than 3500 Women Following Primary Augmentation: 5-Year Data From the Breast Implant Follow-Up Study. Aesthet Surg J. 2018 Aug 27.

- Long-Term Safety of Textured and Smooth Breast Implants. Aesthet Surg J. 2017 Dec 13;38(1):38-48.

- Long-Term Health Outcomes in Women With Silicone Gel Breast Implants: A Systematic Review. Ann Intern Med. 2016 Feb 2;164(3):164-75.

- Eight-year follow-up data from the U.S. clinical trial for Sientra's FDA-approved round and shaped implants with high-strength cohesive silicone gel. Aesthet Surg J. 2015 May;35 Suppl 1:S3-10.

- Natrelle saline-filled breast implants: a prospective 10-year study. Aesthet Surg J. 2009 Jan-Feb;29(1):19-25.

- The safety of silicone gel-filled breast implants: a review of the epidemiologic evidence. Ann Plast Surg. 2007 Nov;59(5):569-80.

- A robust collection of ALCL and Breast Implants articles from PRS

Editor-in-Chief, Rod J. Rohrich, MD announces the 2020 awards for the Best Papers in "Plastic and Reconstructive Surgery."

Awards will be presented to all winners as part of Virtual Plastic Surgery- The Meeting 2020. Meet the award winnerson the PSTM portal today!

The editorial and publishing staff scoured data for all manuscripts published in 2019 to determine the number of times each article was read on Ovid and on PRSJournal.com (combined Full-Text and PDF usage) or the 16 months following article publication. This 16-month data was combined to create an average score for each manuscript, placing them on equal footing, independent of publication month. The articles were sorted by score, and selected based on pre-existing categories.

This average data was combined to create a score for each manuscript, placing them on equal footing, independent of publication month. The articles were sorted by score, and selected based on pre-existing categories.

Authors were not allowed to win twice, even for different papers or different awards. The Editor-in-Chief, Co-Editor, Editor-in-Chief Designate, the ASPS Executive Committee, and members of the 2020 PRS Editorial Board were ineligible.

Emerging Author paper- First author and others on a paper who have been authors on fewer than five PRS papers. Only Original articles, experimental, and special topics are considered. Best Special Topic Paper category includes special topic articles in any sub-section of the journal, including "Plastic Surgery Focus."

Editor-in-Chief, Rod J. Rohrich, MD announces the 2021 awards for the Best Papers in "Plastic and Reconstructive Surgery."

Awards are presented to all winners as part of Plastic Surgery- The Meeting 2021 in person and digitally.

The editorial and publishing staff scoured data for all manuscripts published in 2020 to determine the number of times each article was read on PRSJournal.com (combined Full-Text and PDF usage) for the 16 months following article publication. This 16-month data was combined to create an average score for each manuscript, placing them on equal footing, independent of publication month. The articles were sorted by score, and selected based on pre-existing categories.

This average data was combined to create a score for each manuscript, placing them on equal footing, independent of publication month. The articles were sorted by score, and selected based on pre-existing categories.

Authors were not allowed to win twice, even for different papers or different awards. The Editor-in-Chief, Co-Editor, Editor-in-Chief Designate, the ASPS Executive Committee, and members of the 2021 PRS Editorial Board were ineligible.

Emerging Author paper: First author and others on a paper who have been authors on fewer than five PRS papers. Only Original articles, experimental, and special topics are considered. Best Special Topic Paper category includes special topic articles in any sub-section of the journal, including "Plastic Surgery Focus."

Editor-in-Chief, Kevin C. Chung, MD, MS announces the 2022 awards for the Best Papers in "Plastic and Reconstructive Surgery."

Awards are presented to all winners as part of Plastic Surgery- The Meeting 2022 in person and digitally.

The editorial and publishing staff scoured data for all manuscripts published in 2021 to determine the number of times each article was read on PRSJournal.com (combined Ovid usage and Full-Text and PDF usage on PRSJournal.com) for the 16 months following article publication. This 16-month data was combined to create an average score for each manuscript, placing them on equal footing, independent of publication month. The articles were sorted by score, and selected based on pre-existing categories.

This average data was combined to create a score for each manuscript, placing them on equal footing, independent of publication month. The articles were sorted by score, and selected based on pre-existing categories.

Authors were not allowed to win twice, even for different papers or different awards. The Editor-in-Chief, Co-Editor, Editor and Co-Editor Emeritus, the ASPS Executive Committee, and members of the 2022 PRS Editorial Board were ineligible.

Only original articles, experimental, evidence-based measures and guidelines and special topics are considered for all but the "honorable mention" category. Emerging Author paper: First author and others on a paper who have been authors on fewer than five PRS papers. Best Special Topic Paper category includes special topic articles in any sub-section of the journal, including "Plastic Surgery Focus."

• epidemiology
• outcomes questionnaire development
• large database analysis
• survey methodology
• clinical trials
• case-control studies
• qualitative research
• social sciences relating to plastic surgery