Background: Individuals with genetic susceptibility to breast cancer may pursue bilateral prophylactic mastectomy (BPM) and subsequent breast reconstruction. This study aimed to characterize immediate reconstructive trends following BPM. Methods: The ACS-NSQIP database (2010 -2019) was used to examine differences in demographics and operative outcomes based on breast reconstruction technique following BPM and factors predicting reconstruction type. Results: Of 1945 patients (mean age, 43.8 ± 11.3 years), implant-based reconstruction (IBR) was most frequently (71.8%) performed following BPM. Patients who underwent IBR (n = 1396) were younger (42.6 years, P < 0.001), more likely to be White (P < 0.05), and more likely to have a BMI less than 25 (P < 0.001). Patients who underwent autologous reconstruction (AR) (n = 186, 45.8 years) were more likely to be Black or African American and have a BMI of 25–30. Patients who underwent mastectomy only (MO) without immediate reconstruction (n = 363) were older (47.6 years), more likely to be Asian, and more likely to have a BMI greater than 35. The MO cohort had the highest frequency of diabetes or smoking history. AR was associated with longer operations, longer lengths of stay, and increased complications. Increasing age and BMI were predictive of AR or MO compared to IBR. Smoking was predictive of MO. Conclusion: This is the first large-scale study of genetically susceptible patients who underwent BPM demonstrating a significant relationship between patient demographics, operative outcomes, and immediate reconstruction technique. These results provide valuable insight for surgeons and patients during the shared decision-making process.

Background Debate exists surrounding the morphological evolution of the submandibular gland (SMG) with aging, and due to the inconclusive influence of patient demographics, there remains hesitancy to incorporate targeted interventions of the SMG into clinical practice. Objectives To determine whether SMG ptosis, hypertrophy, or both is the primary etiology behind increased submandibular volume as one ages. Methods MRI segmentation was used to calculate the total and inframandibular (IM) volume and height of the SMG. Adult subjects with prior MRIs of the head and neck were used for analysis. Those with pathology or artifact compromising the SMG were excluded. Subjects were divided into four age-defined cohorts, for clinical applicability. Results The study included 129 patients (Females n=65; Male n=64) with a mean age of 52.3 (range 20-85). No significant change in total SMG volume was observed between the reference group and all cohorts. IM-SMG volume of the reference cohort was 5.77 cm 3. All 3 cohorts had a greater IM-SMG volume compared to the reference group. The 45-54 cohort had a mean volume of 6.7 cm 3 (p=.4), the 55-64 cohort, 7.5 cm 3 (p=.01), and the 55-64 cohort, 7.2 cm 3 (p=.01). Male sex and overweight or obese BMI were associated with significantly larger total and IM-SMG volumes. Conclusions The novel finding of a significantly larger IM-SMG volume with no change in total volume provides evidence for SMG ptosis rather than hypertrophy as a significant contributor to age-related submandibular fullness. Given no significant difference in total volume or height with aging emphasizes glandular descent.

Background Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. Objectives This study aims to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. Methods A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing versus no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. Results The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the two groups diminished by POD 2. Patients having received throat packs also demonstrated a higher usage of opioids in post anesthesia care unit (PACU). The incidence of PONV was not significantly different between the two cohorts at any point of observations. Conclusions This study demonstrates results that largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering this data, we do not recommend routine use of throat packing during elective septorhinoplasty.

Background Recently we have seen an expanding practice of targeting the deeper, subplatysmal structures in the neck. In particular, interventions targeting the “bulky” anterior digastric (AD) muscle have been described with excellent results. However, much remains to be understood about the deep anatomy of the neck and the age-associated changes of the AD. Objectives To examine the relationship between AD volume and age. Methods This retrospective study calculated the AD volume utilizing MRI segmentation in subjects between the ages of 20-92 with prior MRIs. Those with compromised imaging due to pathology or artifact were excluded. Subjects were divided into four age-defined cohorts for clinical applicability. Results This study included 129 patients (male n=64) with a mean age of 52.3. The AD volume of the reference group was 3.2 cm3. A linear decrease in muscle volume was observed with age compared to the reference group: age 45-54 cohort, 2.95 cm3 (p=.3), 55-64 cohort, 2.7 cm3 (p=.05) and &gt;65 cohort, 2.45 cm3 (p&lt;0.001). Male sex (p=.0001) and laterality (p=.003) were associated with significantly larger volumes. Overweight and obese BMI classification was not associated with a significantly different volume than normal or underweight subjects (p=.067). Conclusions Our findings suggest an age-associated reduction in AD volume. Gender and laterality significantly affected volume, while BMI did not. While our results do not support the theory of muscular hypertrophy with aging, they reveal that the perceived bulkiness may be due to changes in the surrounding anatomy affecting the morphology of the AD and subsequent blunting of the cervicomental angle.

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