Background: Nipple-sparing mastectomy (NSM) is emerging as the standard of care for treatment of breast cancer because of its oncologic safety and superior aesthetic outcomes. However, ischemia or necrosis of the skin flap and/or nipple-areola complex remain frequent complications. Hyperbaric oxygen therapy (HBOT) has emerged as a potential adjunct for flap salvage, although it is not currently a widely accepted practice. Here we review our institution's experience using a protocol of HBOT in patients with signs of flap ischemia or necrosis after NSM. Methods: Retrospective review identified all patients treated with HBOT at our institution's hyperbaric and wound care center because of signs of ischemia after NSM. Treatment parameters consisted of 90-minute dives at 2.0 atmosphere once or twice daily. Patients unable to tolerate dives were considered a treatment failure, whereas those lost to follow-up were excluded from analysis. Patient demographics, surgical characteristics, and treatment indications were recorded. Primary outcomes assessed were flap salvage (no operative revision), need for revision procedures, and treatment complications. Results: A total of 17 patients and 25 breasts met the inclusion criteria. The mean ± SD time to initiation of HBOT was 9.47 ± 12.7 days. The mean ± SD age was 46.7 ± 10.4 years, and mean ± SD follow-up time was 36.5 ± 25.6 days. Indications for NSM included invasive cancer (41.2%), carcinoma in situ (29.4%), and breast cancer prophylaxis (29.4%). Initial reconstruction included tissue-expander placement (47.1%), autologous reconstruction with deep inferior epigastric flaps (29.4%), and direct-to-implant reconstruction (23.5%). Hyperbaric oxygen therapy indications included ischemia or venous congestion for 15 breasts (60.0%) and partial thickness necrosis for 10 breasts (40.0%). Flap salvage was achieved in 22 of 25 breasts (88.0%). Reoperation was required for 3 breasts (12.0%). Hyperbaric oxygen therapy-related complications were observed in 4 patients (23.5%), which included 3 patients with mild ear pain and 1 patient with severe sinus pressure leading to treatment abortion. Conclusions: Nipple-sparing mastectomy is an invaluable tool for breast and plastic surgeons to achieve oncologic and cosmetic goals. However, ischemia or necrosis of the nipple-areola complex or mastectomy skin flap remains frequent complications. Hyperbaric oxygen therapy has emerged as a possible intervention for threatened flaps. Our results demonstrate the utility of HBOT in this population to achieve excellent NSM flap salvage rates.

Youth‐onset type 2 diabetes mellitus is associated with a more rapid decline in β cells, and earlier onset of medical complications compared to adult‐onset diabetes. However, its impact on surgical wounds remains less clear. Therefore, this study aimed to determine whether youth‐onset diabetes is a risk factor for wound healing complications in the 30‐day postoperative period. To do so, the National Surgical Quality Improvement Program Database years 2012–2019 was analysed. Patients aged 18–24 with non‐insulin‐dependent diabetes were included. Outcomes assessed included wound infections, wound dehiscence, readmissions, and reoperation. Univariate analysis identified differences between the diabetic and non‐diabetic cohorts after which, multivariate logistic regression was employed to control for potential confounding. Analysis included 1589 diabetic and 196,902 non‐diabetic patients ages 18–24. The diabetic cohort exhibited a higher proportion of female (83.8% vs. 55.2%, p < 0.001), non‐white (22.7% vs. 19.5%, p = 0.001), and Hispanic patients (16.2% vs. 13.6%, p = 0.002). Diabetic patients were less likely to have dirty or contaminated wounds (16.2% vs. 25.2%, p < 0.001); however had increased rates of superficial surgical site infections (SSSIs; 2.0% vs. 0.8%, p < 0.001) and readmission (4.0% vs. 3.0%, p = 0.026). After regression, diabetes remained a significant positive predictor of SSSI (odds ratio: 1.546, p = 0.022); however, it no longer significantly predicted 30‐day readmission. Overall, this analysis of a large multicentre surgical outcomes database found that when compared to non‐diabetics, youth‐onset diabetic patients exhibited a higher proportion of SSSIs in the 30‐day postoperative period. These infections were found, despite the diabetic cohort exhibiting lower rates of wound contamination. After controlling for confounding variables, youth‐onset diabetes remained a significant predictor of SSSI. Clinically, prevention and treatment of diabetes along with judicious wound care is recommended.

Liposuction is a relatively safe surgical procedure, with most complications being minor in nature. However, there are a few life-threatening complications that should not be underestimated. We present a case of a patient who developed bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after combined liposuction and abdominoplasty. Although this presentation is rare, clinicians should keep a high index of suspicion in patients presenting with shortness of breath, chest pain, and/or abdominal pain after liposuction.

Dear Editor, Terbinafine (Lamasil™) is an oral antifungal approved for the treatment of dermatophyte-induced onychomycosis in adults. 1 Terbinafine acts as a non-competitive inhibitor of squalene epoxidase, inhibiting fungal membrane production, and causing cell death secondary to intracellular squalene accumulation. 1 Adverse events related to Terbinafine are well documented, occurring in more than one in 10 patients. 2 Most adverse events are mild and self-limited examples include headaches, gastrointestinal symptoms, and rash. 1 Severe adverse events are less common, and include toxic epidermal necrolysis, cutaneous or systemic lupus erythematosus, and fulminant hepatitis among others. 1 Hilliard T. Brydges and Ogechukwu C. Onuh contributed equally to the production of this manuscript.

Background There has been increasing demand for aesthetic surgery procedures in the United States, highlighting the critical importance of competence of plastic surgery residents and rigorous methods of aesthetic surgery training. Objectives The objective of this study was to review procedures and outcomes from our plastic surgery resident aesthetic clinic. Outcomes and costs were compared to national averages and reports from the literature. Methods A retrospective chart review identified all adult patients who presented to the Resident Aesthetic Surgery Clinic at NYU Langone Health in 2021. Patient demographics, comorbidities, procedural data, postoperative complications, revisions, and surgeon fees were compiled. A brief confidence survey was distributed to participating residents before and after their clinic rotation. Data were analyzed using IBM SPSS software (Armonk, NY). Results In 2021, 144/379 consultations led to an operation (38.0% conversion rate), resulting in 420 distinct surgical procedures. The majority (53.3%) of procedures involved the head and neck. Complication and revision rates were 5.5% and 1.0%, respectively, with surgeon fees consistently below national average. Residents reported being significantly more confident performing face lifts, rhinoplasties, and aesthetic surgery in general following their clinic rotation. Conclusions These data represent the largest annual reported study of plastic surgery resident aesthetic procedures and outcomes, demonstrating the high volume and productivity of the NYU Resident Aesthetic Surgery Clinic. These results further support resident aesthetic clinics as a robust training modality.