Plastics in Practice (Resident Review)

Plastics in Practice
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A podcast built for plastic surgery trainees. Each episode reviews CME articles and topics from the ASPS Resident Curriculum, breaking them down into core concepts, clinical pearls, and exam-ready takeaways. Listen on your commute, between cases, or while studying—anywhere you want high-yield plastic surgery learning on the go.

  1. 3D AGO

    Management of Breast Cancer

    Breast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals. In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center. Key takeaways: Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30. Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo). Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control. Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT. Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven. Disclaimer: This content is for educational purposes only and is not medical advice. #BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKAYouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZApple: https://podcasts.apple.com/us/podcast/plastics-in-pracAmazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ Citations (AMA): Saslow D, Boetes C, Burke W, et al. CA Cancer J Clin. 2007;57(2):75-89. doi:10.3322/canjclin.57.2.75. PMID:17392385. Fisher B, Redmond C, Poisson R, et al. N Engl J Med. 1989;320(13):822-828. PMID:2927449. Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786. Giuliano AE, Hunt KK, Ballman KV, et al. JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90. PMID:21304082. Fisher B, Costantino J, Redmond C, et al. N Engl J Med. 1993;328(22):1581-1586. doi:10.1056/NEJM199306033282201. PMID:8292119. Fisher B, Dignam J, Wolmark N, et al. Lancet. 1999;353(9169):1993-2000. doi:10.1016/S0140-6736(99)05036-9. PMID:10376613.

    15 min

  2. 6D AGO

    Gynecomastia Management

    Gynecomastia isn’t “just fat.” It’s a spectrum—ductal tissue, stroma, and fat—driven by hormonal shifts across life stages. In this episode, we walk through a clean clinical framework: etiology → pathology timeline → exam/workup → severity grading → surgical plan, with pearls that prevent the most common aesthetic failures. We cover when you can stop the workup, how to interpret florid vs fibrous disease by duration, and how Simon grading dictates whether you’re doing lipo, excision, pull-through, or formal skin resection. Then we get practical: incision placement, contour strategy, compression, drains, and how to avoid the nightmare complications—hematoma, under-resection, and the classic subareolar “saucer” deformity. Key takeaways Gynecomastia peaks in neonatal, adolescent, and >65 age groups—think T:E ratio shift. Pathology tracks duration: florid 1 yr. Simon grade guides skin management—2b often deserves time + compression before skin excision. Preserve a 1–1.5 cm subareolar cuff to prevent NAC adherence/depression. If lipo leaves a residual “bud,” add pull-through (don’t accept under-resection). Citations (AMA) Rohrich RJ, Ha RY, Kenkel JM, Adams Wand management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003;111(2):909-923. doi:10.1097/01.PRS.0000042146.40379.25. PMID:12560721. Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. 2009;124(1 Suppl):61e-68e. doi:10.1097/PRS.0b013e3181aa2dc7. PMID:19568140. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52. doi:10.1097/00006534-197301000-00009. PMID:4687568. Hammond DC, Arnold JF, Simon AM, Capraro PA. Combined use of ultrasonic liposuction with the pull-through technique for the treatment of gynecomastia. Plast Reconstr Surg. 2003;112(3):891-895. doi:10.1097/01.PRS.0000072254.75067.F7. PMID:12960873. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Gynecomastia #PRS #SurgeryEducation #Residency #AestheticSurgery #Liposuction 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

    13 min

  3. FEB 7

    Vertical Reduction Mammaplasty

    Vertical reduction mammaplasty represents a fundamental shift in breast reduction philosophy. Instead of relying on skin tension to maintain shape, the vertical approach prioritizes internal parenchymal architecture to create durable projection, narrower bases, and reduced scarring. In this episode of Plastics in Practice, we break down the core principles of Hall-Findlay’s vertical reduction mammaplasty, focusing on how breast shape is determined by tension-free pillar closure—not a “skin brassiere.” We review anatomical foundations, marking strategies, pedicle selection, and operative techniques that consistently produce superior aesthetic outcomes. Key topics include: Why nipple position should be based on the upper breast border, not the suprasternal notch The rationale behind the “snowman” skin resection Medial vs superomedial pedicles and their impact on vascular reliability and sensation Management of postoperative puckering and expectations for skin adaptation Common pitfalls, including under-resection and premature revision This episode is designed for plastic surgery residents and early attendings looking to understand why the vertical technique works—not just how to perform it. Final breast shape comes from parenchymal pillars, not skin tension Vertical techniques improve projection and base width compared to inverted-T Medial pedicles demonstrate the highest sensation recovery (~85%) Inferior puckering is expected and usually resolves without intervention Predetermined resection weights help avoid under-reduction Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #BreastReduction #VerticalMammaplasty #PRS #Residency #HallFindlay #SurgicalEducation Hall-Findlay EJ. Vertical breast reduction. Plast Reconstr Surg. PMID: 12711950. Hall-Findlay EJ. Pedicles in vertical breast reduction. Clin Plast Surg. PMID: 15576215.

    14 min

  4. FEB 6

    Inverted-T Breast Reduction: Pedicles That Actually Work

    Macromastia reduction is where reconstructive principles collide with aesthetic outcomes—and the inverted-T (Wise) pattern stays dominant because it’s predictable. In this episode, we walk through the anatomic “non-negotiables” for NAC perfusion + sensation, then translate that into practical pedicle selection (inferior, superomedial, central mound, and vertical bipedicle) for the real cases: large breasts, ptosis, and gigantomastia. What you’ll learn: Triple-source vascular logic (medial perforators/internal mammary, lateral thoracic, intercostals) and why collateralization matters in big moves. 1 NAC sensation: protecting the lateral cutaneous branch of the 4th intercostal nerve and how pedicle choice influences risk. 1 When inverted-T is the safer “teaching pattern” (large volume + skin excess) vs when vertical strategies make sense. 1,2 Inferior vs superomedial: complication profiles and what changes in large-volume reductions. 3 Free nipple grafting: true indications, functional tradeoffs, and evolving alternatives (extended/elongated pedicles). 4,5 Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Residency #BreastReduction #ReductionMammaplasty #WisePattern #InvertedT #NippleAreolaComplex #AestheticSurgery Citations (AMA) — in text shown as #References (numbered): Study Guide – Breast Reduction: The Inverted-T Technique and Pedicle Variations. Serra MP, et al. Breast reduction with a superomedial pedicle and a vertical scar… PMID: 20179472. Ogunleye AA, et al. Complications After Reduction Mammaplasty… PMID: 28328638. Talwar AA, et al. Outcomes of Extended Pedicle Technique vs Free Nipple Graft… PMID: 36161307. Bonomi F, et al. Is free nipple grafting necessary… PMID: 38183875.

    14 min

  5. FEB 5

    Augmentation Mastopexy - Strategies & Pitfalls

    Ptosis + volume loss is the classic “deflated upper pole in a stretched envelope” problem—and mastopexy-augmentation is where planning mistakes become revisions. This episode breaks down how to choose the right mastopexy pattern, when augmentation alone is enough, and the technical pitfalls that drive complications (especially scarring, malposition, and ischemic risk). We’ll walk through ptosis classification (Regnault), a nipple elevation + desired volume algorithm, and the practical tradeoffs between circumareolar, vertical (circumvertical), and Wise-pattern approaches. You’ll also get a clean framework for deciding one-stage vs staged augmentation-mastopexy, plus what to watch for in secondary cases (prior pedicles, thinning tissues, capsular work, “snoopy” and “ball-in-sock” deformities). Key takeaways (resident-focused): Match technique to required nipple elevation and volume goal—not scar preference. Minimize undermining to protect NAC + skin flap perfusion. Conservative skin markings in aug-mastopexy: implants change nipple-to-fold geometry. One-stage is reasonable in good candidates; high-risk patients should usually stage. Revision drivers are often scar-related, not the “pattern” itself. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Mastopexy #BreastAugmentation #AestheticSurgery #PRS #Residency Citations (AMA): Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg. 1976;3(2):193-203. Rohrich RJ, Thornton JF, Jakubietz RG, Jakubietz MG, Grunert JG. The limited scar mastopexy. Plast Reconstr Surg. 2004;114(6):1622-1630. Spear SL, Dayan JH, Clemens MW. Augmentation mastopexy. Clin Plast Surg. 2009;36(1):105-115. Stevens WG, Freeman ME, Stoker DA, Quardt SM, Cohen R, Hirsch EM. One-stage mastopexy with augmentation: 321 patients. Plast Reconstr Surg. 2007;120(6):1674-1679. Stevens WG, Stoker DA, Freeman ME, Quardt SM, Hirsch EM. Mastopexy revisited: 150 cases. Aesthet Surg J. 2007;27(2):150-154. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

    17 min

  6. FEB 4

    Breast Augmentation: General Principles and Outcomes

    Breast augmentation is one of the most performed aesthetic operations—and still one of the most revised. This episode is a practical, surgeon-to-surgeon breakdown of how to drive reoperations down by treating planning as the operation. We walk through a tissue-based philosophy: objective measurements (not cup-size promises), pocket selection that matches coverage needs, and operative decisions that prevent predictable failures like malposition, rippling, and capsular contracture. Key takeaways (resident-focused): Reoperation rate is the scoreboard—plan backwards from the revision causes. Use objective sizing frameworks (e.g., High Five™ / TEPID) to reduce size-exchange revisions. Dual-plane logic: coverage where you need it, expansion where you want it—without iatrogenic damage. Rippling prevention is coverage math (pinch thickness rules matter). Capsular contracture: think contamination + biofilm risk; incision choice and technique aren’t “small details.” BIA-ALCL: know the textured implant association and the classic delayed seroma presentation. Disclaimer: This content is for educational purposes only and is not medical advice. Hashtags: #PlasticSurgery #BreastAugmentation #AestheticSurgery #PlasticsResidency #CapsularContracture #DualPlane #BIAALCL Citations (AMA; numbered; alphabetical bibliography): Tebbetts JB, Adams WP Jr. Five critical decisions in breast augmentation using five measurements in 5 minutes: the High Five decision support process. Plast Reconstr Surg. 2005;116(7):2005-2016. PMID: 16327616. Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg. 2002. PMID: 11964998. Pajkos A, et al. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg. 2003. PMID: 12655204. Li S, et al. Capsular contracture rate after breast augmentation with periareolar versus other incisions: a meta-analysis. Aesthetic Plast Surg. 2018. PMID: 28916908. Sharma B, et al. Breast implant–associated anaplastic large cell lymphoma. Lancet Oncol. 2020. PMID: 32302264. 6. U.S. Food & Drug Administration. FDA requests Allergan recall of BIOCELL textured breast implants (2019). 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

    15 min

  7. 12/10/2025

    Muscle vs. Fasciocutaneous Flaps: The Lower Extremity Debate

    In this episode of Plastics in Practice, we break down one of the most enduring debates in reconstructive microsurgery: Muscle vs. Fasciocutaneous (FC) flaps for lower limb trauma. For decades, residents were taught that muscle was mandatory for open fractures and osteomyelitis due to its superior vascularity and dead-space obliteration. But does the modern evidence support this? We analyze landmark papers including the massive retrospective review by Yazar et al. and the controlled osteomyelitis study by Salgado et al., which suggest clinical equivalence between the two tissue types. We also dive into the biological nuances reviewed by Chan et al., highlighting why muscle might still hold the edge in specific scenarios—and how chimeric flaps offer a "best of both worlds" solution. Key Takeaways for Residents: Debridement is King: The single most critical factor for success is not the tissue type, but the adequacy of the debridement. Clinical Equivalence: For distal third and ankle defects, FC flaps show statistically equivalent rates of flap survival, infection, and union compared to muscle flaps. The Practical Edge: FC flaps offer superior aesthetics, less donor morbidity, and are easier to re-elevate for secondary orthopedic procedures (hardware removal/bone grafting). Biological Nuance: Muscle tissue retains biological superiority (osteogenic potential and antimicrobial properties) for deep, complex, 3D dead spaces. The Chimeric Solution: Consider chimeric flaps (e.g., ALT + Vastus Lateralis) to combine biological dead-space filling with cutaneous coverage. Citations: Yazar S, Lin CH, Lin YT, et al. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle open tibial fractures. Plast Reconstr Surg. 2006;117(7):2468-2475. doi:10.1097/01.prs.0000224304.56885.c2 Salgado CJ, Mardini S, Jamali AA, et al. Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plast Reconstr Surg. 2006;118(6):1401-1411. doi:10.1097/01.prs.0000239579.37760.92 Chan JK, Harry L, Williams G, Nanchahal J. Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg. 2012;130(2):284e-295e. doi:10.1097/PRS.0b013e3182589e63 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ   Disclaimer: This content is for educational purposes only and is not medical advice.

    14 min

  8. 10/06/2025

    Foot & Ankle Reconstruction: Applying the Subunit Principle

    Foot and ankle reconstruction is a battlefield of function and form. Every subunit has its own demands — the dorsum needs thin, pliable coverage; the heel demands durable, glabrous-like skin. In this landmark PRS 2010 paper, Hollenbeck et al. applied the subunit principle to 165 free flaps, giving surgeons a blueprint for tailored, long-term reconstruction success. Summary:This episode breaks down the seven distinct subunits of the foot and ankle, each with unique reconstructive goals. We discuss the data behind flap outcomes, limb salvage (89% at 5 years), and complication rates, including the common pitfalls like flap debulking and late ulceration — especially in the heel subunit.We’ll explore how subunit-based flap planning improves durability, shoe-fit, and overall limb function — plus, how specific flaps like the radial forearm, ALT, and latissimus dorsi perform across zones. Key Takeaways: 7 subunits = 7 reconstructive goals. Heel (Subunit 5) = highest instability risk. Mean ambulation: 3.1 months. Limb salvage: 89% at 5 years. Subunit mapping improves both form and function. Citation: Hollenbeck ST, Woo S, Komatsu I, et al. Longitudinal Outcomes and Application of the Subunit Principle to 165 Foot and Ankle Free Tissue Transfers. Plast Reconstr Surg. 2010;125(3):924–934. DOI: 10.1097/PRS.0b013e3181cc9630 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

    10 min
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A podcast built for plastic surgery trainees. Each episode reviews CME articles and topics from the ASPS Resident Curriculum, breaking them down into core concepts, clinical pearls, and exam-ready takeaways. Listen on your commute, between cases, or while studying—anywhere you want high-yield plastic surgery learning on the go.

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