Background High-quality evidence on perforator selection in deep inferior epigastric perforator (DIEP) flap harvesting is lacking, making preoperative planning and choice of perforators “surgeon-specific.” This lack of consensus is a subject of continuous debate among microsurgeons. We aimed to systematically review perforator characteristics and their impact on DIEP flap breast reconstruction outcomes. Methods We conducted a systematic review and meta-analysis across six databases: ClinicalTrials.gov, Cochrane Library, Medline, Ovid Embase, PubMed, and Web of Science for all studies on DIEP flap breast reconstruction focused on perforator characteristics—caliber, number, and location. The primary goal was to analyze the impact of perforator characteristics on partial and/or total flap failure and fat necrosis. Data was analyzed using RevMan V5.3. Results Initial search gave us 2,768 articles of which 17 were included in our review. Pooled analysis did not show any statistically significant correlations between partial and/or total flap failure and perforator number, or perforator location. Sensitivity analysis accounting for heterogeneity across studies showed that, the risk for fat necrosis was significantly higher if single perforators (relative risk [RR] = 2.0, 95% confidence interval [CI] = 1.5–2.6, I 2 = 39%) and medial row perforators (RR = 2.7, 95% CI = 1.8–3.9, I 2 = 0%) were used. Conclusion Our findings suggest that a single dominant perforator and medial row perforators may be associated with higher risk of fat necrosis after DIEP flap breast reconstruction. Adopting a standardized perforator selection algorithm may facilitate operative decision making, shorten the learning curve for novice surgeons, and optimize postoperative outcomes by minimizing the burden of major complications. This in turn would help improve patient satisfaction and quality of life.

Background In 2014, the Plastic Surgery Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) increased minimum aesthetic surgery requirements. Consequently, the resident aesthetic clinic (RAC) has become an ever more important modality for training plastic surgery residents. Objectives To analyze demographics and long-term surgical outcomes of aesthetic procedures performed at the Johns Hopkins and University of Maryland (JHUM) RAC. A secondary objective was to evaluate the JHUM RAC outcomes against those of peer RACs as well as board-certified plastic surgeons. Methods We performed a retrospective chart review of all patients who underwent aesthetic procedures at the JHUM RAC between 2011 to 2020. Clinical characteristics, minor complication rates, major complication rates, and revision rates from the JHUM RAC were compared against two peer RACs. We compared the incidence of major complications between the JHUM RAC and a cohort of patients from the CosmetAssure (Birmingham, AL) database. Pearson’s chi-square test was used to compare complication rates between patient populations, with a significance set at 0.05. Results Four hundred ninety-five procedures were performed on 285 patients. The major complications rate was 1.0% (n = 5). Peer RACs had total major complication rates of 0.2% and 1.7% (P = 0.07 and P = 0.47, respectively). CosmetAssure patients matched to JHUM RAC patients were found to have comparable total major complications rates of 1.8% vs 0.6% (P = 0.06), respectively. At JHUM, the minor complication rate was 13.9% while revision rate was 5.9%. Conclusions The JHUM RAC provides residents the education and training necessary to produce surgical outcomes comparable to peer RACs as well as board certified plastic surgeons.