Background Vascularized gastroepiploic lymph node flaps have become a popular option to treat patients with extremity lymphedema. Overall, 2 surgical approaches to harvest this flap have been described: laparoscopic and open. In this study, we analyzed complications, harvesting time, and patient satisfaction scores, comparing these 2 techniques. Methods Between 2012– and 2018, all patients with extremity lymphedema and candidates for the gastroepiploic flap harvest were included. Two groups were compared: open and laparoscopic approaches. Flap harvest time, postoperative pain, complications, return of gastrointestinal motility, time to discharge, and patient satisfaction scores were assessed. Results A total of 177 patients were included, of which 126 underwent laparoscopic harvest and 51 patients underwent open approach. Only 2 patients in the laparoscopic group had prior abdominal surgery not related to cancer treatment compared with 7 patients in the open approach (P < 0.01). Average surgical completion time for the laparoscopic versus open approach was 136 and 102 minutes, respectively (P < 0.02). Postoperative complications for the laparoscopic versus open were as follows: 1 patient developed pancreatitis and 2 developed ileus in the laparoscopic approach, whereas 3 patients developed ileus, 1 developed small bowel obstruction, 2 developed superficial site infection, and 1 developed minor wound dehiscence in the open approach. No patient required further surgical intervention. Average return of gastrointestinal function was 1 day (laparoscopic) and 2 days (open), respectively. On a pain scale, pain scores at postoperative day 1 and upon discharge were on average 3 versus 7 and 2 versus 5, respectively (P < 0.05). Lengths of hospital stay were on average 2 days in the laparoscopic group and 5 days in the open group (P < 0.001). Patient satisfaction scores based on pain and scars were significantly better in the laparoscopic group versus open group (P < 0.03). Conclusions These data support that a minimal invasive approach is ideal and efficient when resources are available. In addition, the lower complication rate and high patient satisfaction scores give promising feedback to continue offering this technique.

Facial gender confirmation surgery (FGCS) is a powerful set of procedures in the armamentarium of plastic surgeons that can transform the male face into a gender-congruent female face and provide the transgender individual with improved quality of life, positive body image and help in social integration. The goals of the FGCS procedures are to address the individual patients' concerns and expectations about their facial appearance, offer safely executed surgery, minimize complications, and optimize surgical outcomes.Pre-operative computed tomography (CT) scanning and three-dimensional (3D) reconstruction before facial feminization or masculinization delineates important skeletal and sinus anatomy and can also be a useful tool in patient consultation. Virtual surgical planning (VSP) is a valuable tool in facial surgery. From free flap bony reconstruction after tumor resection and orthognathic surgery to craniosynostosis planning, VSP has become widely utilized in modern day cranio-maxillofacial surgery. The use of patient-specific cutting guides and implants helps in improving symmetry and safety of these procedures. Furthermore, 3D printed models are valuable tools in patient education and counseling prior to surgery. In this article we describe our approach to FGCS through the integration of point of care (POC) VSP and 3D printing (3DP) to help deliver safer and accurate FGCS outcomes.

Nipple-areola complex (NAC) reconstruction in transgender and gender non-binary (TGNB) individuals undergoing chest wall masculinization surgery is critical for adequate satisfaction and aesthetic results. Here, we conducted a systematic review to find the various techniques and outcomes of NAC reconstruction in double-incision mastectomy and free nipple grafts (DIM-FNG). A comprehensive search of several databases was conducted based on PRISMA guidelines. We included studies that described the NAC reconstruction technique after DIM-FNG, and evaluated the surgical outcomes, or satisfaction, or aesthetic results after a minimum duration of follow-up of 6 months. Studies were assessed for risk of bias.A qualitative synthesis was performed. A total of 19 studies, comprising 1,587 patients (3,174 breasts), were included. There was a total of 14 studies using the conventional FNG technique, 4 describing new approaches for NAC reconstruction in FNG and 1 study comparing the conventional FNG technique to another alternative technique. A total of 1,347 patients underwent DIM-FNG with conventional FNG and 240 underwent alternative techniques for NAC reconstruction after DIM-FNG. Postoperative complications were low, and satisfaction was high for conventional and alternative techniques. Newer techniques aim to reshape the new NACs in an oval shape, reduce nipple size and place the NACs using the pectoralis major lateral and inferior borders as reference. In addition, a horizontal oval incision at the recipient site may avoid an undesired vertical NAC.

Background: Since its first description in 2012, the Goldilocks procedure has become an option for immediate breast reconstruction, particularly for obese patients who are poor candidates for traditional implant or autologous reconstruction. In this work, the authors performed a longitudinal study of patients who underwent mastectomy with Goldilocks reconstruction to assess the incidence of additional surgical procedures, and to assess surgical outcomes and patient satisfaction. Methods: A retrospective review of patients who underwent mastectomy with the Goldilocks procedure only at Mayo Clinic Rochester between January of 2012 and September of 2019 was performed. Demographics, complications, additional breast procedures performed to attain the final results, and patient-reported outcomes using the BREAST-Q were recorded. Univariate and multivariable analyses were performed to identify statistical associations and risk factors. Results: Sixty-three patients (108 breasts) were included. Mean age was 57.8 years. Mean body mass index was 37.6 kg/m2. Median follow-up time after the mastectomy with the Goldilocks procedure was 15 months. The major complication rate within the first 30 days was 9.3 percent. Forty-four breasts (40.7 percent) underwent additional surgery. Dyslipidemia was significantly associated with an increased risk of additional surgery (adjusted hazard ratio, 2.00; p = 0.045). Scores in the four BREAST-Q domains were not statistically different between patients who had additional procedures and those who did not. Conclusions: Based on the results, the authors recommend a thorough preoperative discussion with patients who are candidates for the Goldilocks procedure to explore all options for reconstruction and their expectations, because it is crucial to reduce the necessity for additional operations in this high-risk population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.