Debra Johnson

The Vascular Supply to the Skin: An Anatomical and Physiological Reappraisal—part Ii

The subcutaneous vascular system demonstrated in the first part of this study augments skin flap survival when included within human abdominal flaps. Flaps with larger subcutaneous vessels will survive to a greater length than flaps supplied solely by the subdermal plexus. Knowledge of the subcutaneous vascular system is applicable to breast reduction, subcutaneous mastectomy, and abdominal lipectomy.

Carbon Dioxide-Based versus Saline Tissue Expansion for Breast Reconstruction: Results of the XPAND Prospective, Randomized Clinical Trial.

Background: AeroForm is a new type of remote-controlled, needle-free, carbon dioxide–based expander involving a potentially faster method of tissue expansion. Results are presented here from the AirXpanders Patient Activated Controlled Tissue Expander pivotal trial comparing AeroForm to saline tissue expanders. Methods: Women undergoing two-stage breast reconstruction were randomized at 17 U.S. sites in this U.S. Food and Drug Administration–approved investigational device exemption trial. Expansion in the investigational arm was performed by the patient in 10-cc increments up to 30 cc/day of carbon dioxide and in the control arm by the physician with periodic bolus injections of saline. Safety endpoints, expansion and reconstruction times, pain, and satisfaction were assessed. Results: One hundred fifty women were treated: 98 with carbon dioxide expanders (n = 168) and 52 with saline expanders (n = 88). The treatment success rate (all breasts exchanged successfully excluding non–device-related failures) was 96.1 percent for carbon dioxide and 98.8 percent for saline. Median time to full expansion and completion of the second-stage operation was 21.0 and 108.5 days (carbon dioxide) versus 46.0 and 136.5 days (saline), respectively, with a similar rate of overall complications. Ease of use for the carbon dioxide expander was rated high by patients (98 percent) and physicians (90 percent). Conclusions: The AirXpanders Patient Activated Controlled Tissue Expander trial results demonstrate that a carbon dioxide–based expander is an effective method of tissue expansion with a similar overall adverse event rate compared to saline expanders, and provides a more convenient and expedient expansion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Melting the Plastic Ceiling: Overcoming Obstacles to Foster Leadership in Women Plastic Surgeons

Summary: The underrepresentation of women leaders in plastic surgery echoes a phenomenon throughout society. The importance of female leadership is presented, and barriers to gender equality in plastic surgery, both intrinsic and extrinsic, are discussed. Strategies for fostering women in leadership on an individual level and for the specialty of plastic surgery are presented.

AeroForm patient controlled tissue expansion and saline tissue expansion for breast reconstruction: a randomized controlled trial.

BackgroundProsthetic reconstruction of the breast, as a 2-staged procedure using tissue expanders followed by placement of permanent implants, offers favorable aesthetic results with minimal additional surgical intervention. However, the current outpatient process to fill saline expanders can be lengthy and onerous, involving months of office visits and discomfort from the bolus saline expansions. We present a new technology (AeroForm Tissue Expansion System), which has the potential to improve the process of breast tissue expansion by providing a method for low-volume incremental filling, eliminating the need for injections and directly involving the patient by allowing her some control over the expansion process. MethodsThe described study is a 2:1 randomized controlled trial of the investigational CO2 expansion system and saline expanders. Of the 82 women receiving expanders, 58 (39 bilateral and 19 unilateral; bilateral rate, 67%) were implanted with CO2 tissue expanders and 24 subjects (15 bilateral and 9 unilateral; bilateral rate, 63%) were implanted with saline expanders. ResultsPreliminary validated expansion results were available for 55 women. Available mean time for active expansion in the CO2 group was 18.2 (9.2) days (median, 14.0; range, 5–39; number of expanders, 53), which was less than the mean time for active expansion in the saline group: 57.4 (33.6) days (median, 55; range, 5–137; number of expanders, 33). Available mean time from implant placement to exchange for a permanent prosthesis in the CO2 group was shorter [106.3 (42.9) days; median, 99; range, 42–237; number of expanders, 53] than for the women in the control group [151.7 (62.6) days; median, 140; range, 69–433; number of expanders, 33]. After 2 events—underexpansion (n = 1) and erosion (n = 1)—in the CO2 group, the internal membrane was redesigned and the expander bulk was decreased to minimize the risk of underexpansion and erosion in subsequent patients. ConclusionsPreliminary evidence indicates that the CO2-based tissue expansion system performs the same function as saline expansion devices without significantly altering the risk to the patient and that the device has the potential to make the expansion process faster and more convenient for both the patient and the physician.

Carbon Dioxide versus Saline Tissue Expanders: Does It Matter?

Background: Implant-based breast reconstruction is the most common reconstructive technique in the United States. Despite its popularity, saline-based tissue expansion still has its limitations, including lengthy expansion times, large uncomfortable bolus dosing, and frequent percutaneous injections/expansion visits. Ideally, a novel technology would eliminate frequent, percutaneous saline injections and allow patients to perform expansion at home, reducing the disruptive experience of current tissue expansion. Methods: Within the past 6 years, the AeroForm tissue expander system has used remotely activated carbon dioxide release as the fill medium instead of saline, eliminating many limitations of traditional tissue expanders. In this article, the authors first review the relevant literature concerning carbon dioxide–based tissue expansion in animal and human models. The authors then analyze the similarities and differences between two groundbreaking human trials (i.e., Patient Activated Controlled Expansion and AirXpanders Patient Activated Controlled Tissue Expander) with carbon dioxide–based expanders and discuss the risks and benefits associated with this new technology. Results: At their site, the authors have enrolled 34 patients using 36 experimental devices in total, and have found significantly shorter expansion and overall reconstruction times in the patient-controlled tissue expander group. Conclusions: The authors believe that carbon dioxide–based devices may play a significant role in the future of implant-based breast reconstruction, and may be widely applicable to other areas of plastic surgery that also involve tissue expansion.

Use of an axial flap for reduction mammaplasty.

&NA; Ten dye injections in cadavers and 21 breast reductions using the inferior pedicle technique with skin removal have confirmed an axial pattern of vascularity to the inferior pedicle and its nipple‐areola. We present a safe anatomical approach for inferior pedicle reduction mammaplasty that centers its base over the fourth and fifth intercostal spaces.

Making the End as Good as the Beginning: Financial Planning and Retirement for Women Plastic Surgeons

Financial planning is critically important to ensure financial security both during a plastic surgical career and in retirement. Unfortunately, plastic surgery training includes very little in the way of financial planning. The information that is available in the literature is mostly geared toward men. Women, with longer lifespans and more family care responsibilities, have unique needs when it comes to financial planning. Adequate attention must also be paid to life after retirement. A plastic surgical career can be all-encompassing, and thus women need to carefully plan volunteer activities, new hobbies, and even a second career to make their retirement years fulfilling and enjoyable. Key points regarding financial planning during the various phases of a woman plastic surgeons career are discussed. Options for retirement are presented.

Aeroform vs Saline Tissue Expansion in Breast Reconstruction: A Prospective Multi-Center Randomized Controlled Clinical Study.

Jeffrey A. Ascherman, MD; Adam Jacoby, MD; Kaveh Alizadeh, MD, FACS; James Appel, MD; R. Laurence Berkowitz, MD; John Castle, MD; Yoon S. Chun, MD; Amy S. Colwell, MD; Ankit R. Desai, MD; Susan E. Downey, MD; Gregory Evans, MD, FACS; Michael Fallucco, MD; Terri Halperin, MD; Scott Hollenbeck, MD; Debra J. Johnson, MD; Khashayar Mohebali, MD; Donald Morris, MD; Tracey Stokes, MD; Laura A. Sudarsky, MD; Kamakshi R. Zeidler, MD