Background: Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies. Methods: The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES. Results: The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02). Conclusions: Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.

Background The use of breast tissue expanders (TE) in breast reconstruction is accompanied by undesired changes to the chest wall and lateral plane. Breast TEs are designed to create a naturally formed breast pocket by capitalizing on the ductile response of skin tissue; however, in practice, the use of expanders is accompanied by undesired changes to the chest wall and lateral plane. Objectives The authors of this study compared 3 comparably sized and commercially available breast TEs to assess the mechanical profile and functionality of each design. Methods Authors compared MENTOR Artoura PLUS Smooth (Irvine, CA), Allergan 133 Smooth (Irvine, CA), and Sientra AlloX2 Smooth (Santa Barbara, CA) filled to 100% of their label volume. The mechanical profile of TEs was assessed via vertical compression. Dimensions were recorded at baseline and percent changes were calculated at each compressive load (5-35 lbf intervals of 5 lbf). Results Base width and projection were recorded at compressive loads of 10, 20, and 35 lbs. For percent changes of base width, MENTOR had 0.98%, 2.09%, 3.84%; Allergan 4.21%, 9.15%, 15.52%; and Sientra 4.72%, 10.19%, 19.15%. For percent changes of projection, MENTOR® had -19.06%, -25.44%, -30.88%, Allergan -35.53%, -42.90%, -50.09%, and Sientra® -29.64%, -37.68%, -44.69%. For percent change of height, MENTOR had 1.44%, 2.62%, 4.27%, Allergan 10.26%, 16.49%, 22.97%, and Sientra 6.99%, 11.93%, 16.90%. MENTOR’s TE had the most pronounced lower pole with volume expansion. Conclusions The MENTOR TE demonstrated the least lateral deformation and projection loss across the range of compressive loads, as well as the highest force resistance compared to the other models.

Introduction:The location of trainees' plastic surgery residency or fellowship has implications on their subsequent careers, which can inform future trainees and faculty decisions, and may affect access to care nationwide. This study explores historic geographic trends of the location where trainees complete residency or fellowship and where they pursue a fellowship program or first job. Methods: Graduates from US integrated plastic surgery residency or fellowship programs from 2015 to 2021 were identified along with their proximity to fellowship or first job. Location was categorized based on whether the graduate's fellowship/first job location to residency/fellowship was within 100 miles, the same state, the same geographic region, the United States, or international. A χ 2 value was calculated to determine the significance of relative geographical location after training. Results: Three hundred sixty-five graduates that attended fellowship were included, representing 76.5% (65/85) of integrated plastic surgery residency programs. There were 47.7% (n = 174) that stayed within the same geographic region and 3.6% (n = 13) pursued training internationally. The location of the residency or fellowship program appears to have an influence on the location of the graduate's fellowship or first job. Conclusion: Graduates who completed integrated residency or fellowship in a certain geographic location were more likely to stay in that area for their fellowship or first job. This may be explained by graduates continuing training with their original program, the established network, and personal factors such as family and friends.

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