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Nolan IT, Farajzadeh MM, Boyd CJ, Bekisz JM, Gibson EG, Salibian AA. Do we need acellular dermal matrix in prepectoral breast reconstruction? A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 86:251-260. [PMID: 37793198 DOI: 10.1016/j.bjps.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma. Comparative studies on prepectoral reconstruction with and without ADM are limited to small, single-institution series. The purpose of this study was to perform a meta-analysis of prepectoral reconstruction with and without ADM. A systematic literature review was performed to identify studies comparing prepectoral reconstruction with and without ADM using PubMed, EMBASE, and Cochrane databases. Pooled rates of patient demographics and outcomes were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complications in studies comparing reconstruction with and without ADM. In total, 515 reconstructions from four studies were included. Most cases were nipple-sparing mastectomies and utilized tissue-expander reconstructions. Meta-analysis demonstrated no significant difference in the rate of complications between cohorts with and without ADM. Short-term complications included reconstructive failure (1.2% in ADM cohort and 2.8% in no-ADM), seroma (1.2% and 8.3%, respectively), hematoma (1.2% and 2.1%), infection (4.7% and 4.2%), and mastectomy flap ischemia and/or necrosis (2.4% and 5.2%). Long-term complications included rippling (3.3% in ADM and 5.1% in no-ADM cohorts) and capsular contracture (6.8% and 3.4%, respectively). This meta-analysis demonstrated no difference in the rate of complications between cases with and without ADM. However, the outcomes data from no-ADM reconstruction mostly reflect robust mastectomy flaps. Surgeon discretion as informed by specific clinical scenarios should guide decisions regarding the use of ADM in prepectoral breast reconstruction.
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Affiliation(s)
- Ian T Nolan
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60607, United States
| | - Matthew M Farajzadeh
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY 10016, United States
| | - Carter J Boyd
- Division of Plastic and Reconstructive Surgery, University of California Davis School of Medicine, Sacramento, CA 95816, United States
| | - Jonathan M Bekisz
- Division of Plastic and Reconstructive Surgery, University of California Davis School of Medicine, Sacramento, CA 95816, United States
| | - Ella G Gibson
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY 10016, United States
| | - Ara A Salibian
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York, NY 10016, United States.
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Nolan IT, Weinstein B, Schechter L. Low Rate of Regret After Gender-Affirming Mastectomy Highlights a Double Standard. JAMA Surg 2023; 158:1077. [PMID: 37556133 DOI: 10.1001/jamasurg.2023.3358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Ian T Nolan
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brielle Weinstein
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Loren Schechter
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
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Nolan IT, Vranis NM, Levine JP. Utilizing augmented reality for Deep Inferior Epigastric Artery Perforator (DIEP) flap perforator selection. Microsurgery 2023; 43:300-301. [PMID: 36734625 DOI: 10.1002/micr.31012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Ian T Nolan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Neil M Vranis
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, New York, USA
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Nolan IT, Shepard E, Swanson M, Morrison SD, Hazen A. Techniques and Applications of Lower Extremity Feminization and Masculinization. Transgend Health 2023; 8:45-55. [PMID: 36895317 PMCID: PMC9991449 DOI: 10.1089/trgh.2020.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Significant differences exist between feminine and masculine lower extremities, and this region contributes to gender dysphoria in transgender and nonbinary individuals. Methods A systematic review was conducted for primary literature on lower extremity (LE) gender affirmation techniques as well as anthropometric differences between male and female lower extremities, which could guide surgical planning. Multiple databases were searched for articles before June 2, 2021 using Medical Subject Headings. Data on techniques, outcomes, complications, and anthropometrics were collected. Results A total of 852 unique articles were identified: 17 met criteria for male and female anthropometrics and 1 met criteria for LE surgical techniques potentially applicable to gender affirmation. None met criteria for LE gender affirmation techniques specifically. Therefore, this review was expanded to discuss surgical techniques for the LE, targeting masculine and feminine anthropometric ideals. LE masculinization can target feminine qualities, such as mid-lateral gluteal fullness and excess subcutaneous fat in the thigh and hips. Feminization can target masculine qualities like a low waist-to-hip ratio, mid-lateral gluteal concavity, calf hypertrophy, and body hair. Cultural differences and patient body habitus, which influence what is considered "ideal" for both sexes, should be discussed. Applicable techniques include hormone therapy, lipo-contouring, fat grafting, implant placement, and botulinum toxin injection, among others. Conclusions Due to lack of existing outcomes-based literature, gender affirmation of the lower extremities will rely on application of an array of existing plastic surgery techniques. However, quality outcomes data for these procedures is required to determine best practices.
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Affiliation(s)
- Ian T. Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Elizabeth Shepard
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Marco Swanson
- Division of Plastic Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shane D. Morrison
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Alexes Hazen
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, New York, USA
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Massie JP, Sood R, Nolan IT, Sasson DC, Swanson M, Morrison SD, Placik O. Defining Aesthetic Preferences for the Penis: A Photogrammetric and Crowdsourcing Analysis. Aesthet Surg J 2021; 41:1293-1302. [PMID: 33569587 DOI: 10.1093/asj/sjab082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Achieving an aesthetic phalloplasty result is important for patients with acquired or congenital defects of the penis, or with genital-related dysphoria. However, aside from length and girth, the aesthetic proportions of the male penis have not been defined. OBJECTIVES This study aimed to determine proportions of the male penis through photogrammetric analysis of nude male photographs and to verify these proportions with a crowdsourcing-based survey. METHODS Nude male photographs (n = 283) were analyzed to define aesthetic proportions of the male penis. Photographs were analyzed for the position of the penis on the torso in relation to the umbilicus and for the ratio of the dorsal and ventral glans of the penis in relation to the entire shaft length. Proportions were then further studied by crowdsourcing 1026 respondents with Amazon mechanical Turk. RESULTS The ideal position of the penis below the umbilicus is about 55% (6/11th) of the distance from the jugular notch to the umbilicus (measured average, 53.6%; survey-weighted average, 58.9%). The dorsal glans of the penis is about 33% (1/3rd) of the length of the entire shaft (measured average, 32.1%; survey-weighted average, 37.5%). The ventral glans of the penis is about 12.5% (1/8th) of the length of the entire shaft (measured average, 12.6%; survey-weighted average, 11.7%). CONCLUSIONS Measured proportions of the human penis follow exact fractions. Crowdsourcing data helped support photogrammetric analysis, with survey-preferred ratios within 5% of measured ratios. With further validation, these data can aid surgeons performing phalloplasty.
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Affiliation(s)
- Jonathan P Massie
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Rachita Sood
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, NYU School of Medicine, New York, NY, USA
| | - Daniel C Sasson
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Marco Swanson
- Division of Plastic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Otto Placik
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Haley C, Lee J, Xun H, Yesantharao P, Nolan IT, Harirah M, Crowe CS, Lopez J, Morrison SD, Drolet BC, Janis JE. The Negative Impact of COVID-19 on Medical Education amongst Medical Students Interested in Plastic Surgery: A Cross-sectional Survey Study. Plast Reconstr Surg Glob Open 2021; 9:e3535. [PMID: 33968558 PMCID: PMC8099393 DOI: 10.1097/gox.0000000000003535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022]
Abstract
Background: The COVID-19 pandemic has resulted in unpreceded changes to medical education. Medical students interested in urology and neurosurgery have reported concerns regarding COVID-19’s effects on clinical experience and the residency application process; however, the impact amongst students interested in plastic surgery is unknown. We hypothesized that students applying into plastic surgery may experience much distress as a result of the COVID-19 pandemic. Methods: An electronic survey was developed by 3 plastic surgery residents and 2 academic plastic surgeons and later refined by 4 fourth-year medical students. Questions focused on medical education curricular changes, perceived impact on medical education, and demographics. From April–May 2020 the survey was distributed to medical students who were interested in plastic surgery. Participants were identified through plastic surgery residency program personnel and social media platforms. Results: In total, 130 of the 140 respondents reported interest in plastic surgery careers. An estimated 67% were in their clinical years or completing research year(s) before residency applications. Of the respondents, 80% believed that the COVID-19 pandemic had a negative impact on their medical education. Clinical-level students compared with preclinical-level students, and students applying to residency during the 2020–2021 match cycle compared with students not applying during the 2020–2021 match cycle were significantly more likely to perceive the COVID-19 pandemic as having a negative impact on their medical education (P = 0.04 and 0.03, respectively). Conclusion: Medical students interested in plastic surgery perceive the COVID-19 pandemic as having a negative impact on their education, likely due to a reduction in clinical exposure.
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Affiliation(s)
- Caleb Haley
- University of Michigan Medical School, Ann Arbor, Mich
| | - Jasmine Lee
- Hansjorg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, N.Y
| | - Helen Xun
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, Md
| | - Pooja Yesantharao
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, Md
| | - Ian T Nolan
- Hansjorg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, N.Y
| | - Muhammad Harirah
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Christopher S Crowe
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph Lopez
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, Md
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Brian C Drolet
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Jeffrey E Janis
- Department of Plastic & Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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Salibian AA, Nolan IT, Bekisz JM, Frey JD, Karp NS, Choi M, Levine JP, Thanik VD. A Systematic Review and Meta-Analysis of Microvascular Stacked and Conjoined-Flap Breast Reconstruction. J Reconstr Microsurg 2021; 37:631-642. [PMID: 33592635 DOI: 10.1055/s-0041-1723820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Stacked and conjoined (SC) flaps are a useful means of increasing flap volume in autologous breast reconstruction. The majority of studies, however, have been limited to smaller, single-center series. METHODS A systematic literature review was performed to identify outcomes-based studies on microvascular SC-flap breast reconstruction. Pooled rates of flap and operative characteristics were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complication rates and outcomes of studies comparing SC flaps to non-SC flaps. Meta-regression analysis identified risk factors for flap complications. RESULTS Twenty-six studies were included for analysis (21 case series, five retrospective cohort studies) for a total of 869 patients, 1,003 breasts, and 2006 flaps. The majority of flaps were harvested from the bilateral abdomen (78%, 782 breasts) followed by combined abdomen-thigh stacked flaps (22.2%, 128 breasts). About 51.1% of flaps were anastomosed to anterograde/retrograde internal mammary vessels (230 breasts) and 41.8% used internal mammary/intraflap anastomoses (188 breasts). Meta-analysis revealed a rate of any flap complication of 2.3% (95% confidence interval: 1.4-3.3%), Q-statistic value p = 0.012 (I 2 = 43.3%). SC flaps had a decreased risk of fat necrosis compared with non-SC flaps (odds ratio = 0.126, p < 0.0001, I 2 = 0.00%), though rates of any flap and donor-site complication were similar. Age, body mass index, flap weight, and flap donor site and recipient vessels were not associated with increased risk of any flap complication. CONCLUSION A global appraisal of the current evidence demonstrated the safety of SC-flap breast reconstruction with low complication rates, regardless of donor site, and lower rates of fat necrosis compared with non-SC flaps.
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Affiliation(s)
- Ara A Salibian
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Jordan D Frey
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Nolan S Karp
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Mihye Choi
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Vishal D Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
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Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice. Aesthet Surg J 2021; 41:NP42-NP51. [PMID: 33565575 DOI: 10.1093/asj/sjaa430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. OBJECTIVES This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. METHODS A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. RESULTS We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. CONCLUSIONS Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Viren Patel
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth Card
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Nolan IT, Haley C, Morrison SD, Pannucci CJ, Satterwhite T. Estrogen Continuation and Venous Thromboembolism in Penile Inversion Vaginoplasty. J Sex Med 2020; 18:193-200. [PMID: 33243691 DOI: 10.1016/j.jsxm.2020.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/18/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Estrogen therapy and penile inversion vaginoplasty (PIV) are necessary, life-saving interventions for many transfeminine patients. Patients undergoing PIV are generally at low baseline risk for venous thromboembolism (VTE) based on Caprini Score. Estrogen therapy may increase VTE risk in surgical patients, but its cessation may be psychiatrically dysphoric for transfeminine patients. AIM This study examines whether perioperative estrogen cessation impacts VTE risk in patients undergoing PIV. METHODS This was a pre-post study of patients undergoing PIV. From 2014 through 2018, all patients stopped estrogen therapy for 2 weeks before surgery and resumed 1 week postoperatively (group 1). Starting in 2019, all patients continued estrogen therapy perioperatively, with dose reductions for those whose dose was >6 mg/day (group 2). OUTCOMES The primary outcome was 90-day VTE rate. RESULTS 178 patients were included in the study, with 117 in group 1 and 61 in group 2. Median Caprini Score was 4 in group 1 (interquartile range: 3-6) and 3 in group 2 (interquartile range: 3-4) (P = .011). Complications per patient were higher in group 1 (2.2 vs 0.9, P < .001), with a longer follow-up (14.1 vs 10.2 months, P < .001). Rates of 90-day VTE were not different between groups (0.0% vs 1.6%, P = .166). CLINICAL IMPLICATIONS Patients undergoing PIV are generally at low risk for VTE, based on 2005 Caprini Scores. This study provides preliminary evidence that perioperative estrogen therapy continuation does not appear to substantially increase VTE risk in transfeminine patients undergoing PIV with low Caprini Scores, although more investigation is needed to establish true safety. STRENGTHS & LIMITATIONS Strengths include the pre-post design and single-surgeon experience, high proportion of patients with 90-day follow-up, and relatively large series to understand baseline VTE risk by Caprini Score in a PIV population. The main weakness of this study is its limited power to measure true differences in VTE risk based on estrogen continuation. CONCLUSIONS This study suggests that perioperative estrogen continuation may be safe for patients undergoing PIV, the overwhelming majority of whom are at low baseline VTE risk. However, clinicians should weigh the magnitude of the risks and benefits of estrogen cessation on a case-by-case basis. Nolan IT, Haley C, Morrison SD, et al. Estrogen Continuation and Venous Thromboembolism in Penile Inversion Vaginoplasty. J Sex Med 2021;18:193-200.
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Affiliation(s)
- Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, Grossman School of Medicine, New York University, New York City, NY, USA.
| | - Caleb Haley
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Tijerina JD, Morrison SD, Nolan IT, Parham MJ, Nazerali R. Predicting Public Interest in Nonsurgical Cosmetic Procedures Using Google Trends. Aesthet Surg J 2020; 40:1253-1262. [PMID: 31574152 DOI: 10.1093/asj/sjz264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Google Trends (GT) provides cost-free, customizable analyses of search traffic for specified terms entered into Google's search engine. GT may inform plastic surgery marketing decisions and resource allocation. OBJECTIVES The aim of this study was to determine GT's utility in tracking and predicting public interest in nonsurgical cosmetic procedures and to examine trends over time of public interest in nonsurgical procedures. METHODS GT search volume for terms in 6 ASPS and ASAPS nonsurgical procedure categories (Botox injections, chemical peel, laser hair removal, laser skin resurfacing, microdermabrasion and soft tissue fillers [subcategories: collagen, fat, and hyaluronic acid]) were compared with ASPS and ASAPS case volumes for available dates between January 2004 and March 2019 with the use of univariate linear regression, taking P < 0.01 as the cutoff for significance. RESULTS Total search volume varied by search term within the United States and internationally. Significant positive correlations were demonstrated for 17 GT terms in all 6 ASPS and ASAPS categories: "Botox®," "collagen injections," "collagen lip injections" with both databases; and "chemical skin peel," "skin peel," "acne scar treatment," "CO2 laser treatment," "dermabrasion," "collagen injections," "collagen lip injections," "fat transfer," "hyaluronic acid fillers," "hyaluronic acid injection," "hyaluronic acid injections," "Juvederm®," and "fat transfer" with just 1 database. Many search terms were not significant, emphasizing the need for careful selection of search terms. CONCLUSIONS Our analysis further elaborates on recent characterization of GT as a powerful and intuitive data set for plastic surgeons, with the potential to accurately gauge global and national interest in topics and procedures related to nonsurgical cosmetic procedures.
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Affiliation(s)
- Jonathan D Tijerina
- Mr Tijerina and Mr Parham are Medical Students, Stanford University School of Medicine, Stanford, CA
| | - Shane D Morrison
- Dr Morrison is a Resident, Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Ian T Nolan
- Mr Nolan is a Medical Student, New York University School of Medicine, New York, NY
| | - Matthew J Parham
- Mr Tijerina and Mr Parham are Medical Students, Stanford University School of Medicine, Stanford, CA
| | - Rahim Nazerali
- Dr Nazerali is an Attending Physician, Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
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Salibian AA, Bekisz JM, Frey JD, Nolan IT, Kaoutzanis C, Yu JW, Levine JP, Karp NS, Choi M, Thanik VD. Comparing outcomes between stacked/conjoined and non-stacked/conjoined abdominal microvascular unilateral breast reconstruction. Microsurgery 2020; 41:240-249. [PMID: 32997369 DOI: 10.1002/micr.30659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stacked and conjoined free flaps are increasingly utilized in autologous breast reconstruction to augment tissue transfer volume. However, there is a paucity of comparative data on abdominally-based stacked/conjoined versus non-stacked/conjoined flaps. The purpose of this study was to compare ability to match native breast size, complications, recovery, and symmetrizing procedures between these two cohorts in unilateral breast reconstruction. METHODS A retrospective review of all stacked (two separate hemiabdominal)/conjoined (bipedicled full abdominal) flaps and non-stacked/conjoined (unipedicled hemiabdominal) flaps in unilateral abdominally-based autologous breast reconstructions was performed from 2011 to 2018. Variables including demographics, operative characteristics, complications, and revisions were compared in 36 stacked/conjoined patients versus 146 non-stacked/conjoined patients. RESULTS The stacked/conjoined cohort had more DIEP flaps (91.7 vs. 65.1%) and the non-stacked/conjoined group more MS-TRAMs (34.2 vs. 6.9%, p = .000). Additionally, non-stacked/conjoined flaps had greater utilization of combined medial and lateral row perforators (p = .000). Mean flap weight was significantly higher than mastectomy weight in stacked/conjoined flaps (+110.7 g) when compared to non-stacked/conjoined flaps (-40.2) (p = .023). Average follow-up was 54.7 ± 27.5 and 54.6 ± 29.3 months, respectively. Stacked/conjoined flaps had lower fat necrosis rates (8.3 vs. 25.4%, p = .039) and had a decreased risk of fat necrosis on multivariable regression analysis (OR 0.278, p = 0.045). There were otherwise no differences in flap, breast, or donor-site complications. Stacked/conjoined flaps also had a lower rate of contralateral breast reduction (p = .041). CONCLUSION Stacked/conjoined flaps were associated with a lower risk of fat necrosis compared with non-stacked/conjoined flaps and had a lower rate of contralateral symmetrizing reductions in patients undergoing unilateral abdominally-based breast reconstruction.
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Affiliation(s)
- Ara A Salibian
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Jordan D Frey
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Christodoulos Kaoutzanis
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Jason W Yu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Nolan S Karp
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Mihye Choi
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Vishal D Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
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Cohen OD, Abdou SA, Nolan IT, Saadeh PB. Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications. J Reconstr Microsurg 2020; 36:616-624. [PMID: 32643763 DOI: 10.1055/s-0040-1713668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof. PATIENTS AND METHODS Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected. RESULTS A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m2. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection. CONCLUSION ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.
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Affiliation(s)
- Oriana D Cohen
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Salma A Abdou
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Pierre B Saadeh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
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13
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Affiliation(s)
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Ian T Nolan
- New York University School of Medicine, New York, NY
| | | | - Rahim Nazerali
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
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Latack K, Adidharma W, Nolan IT, Crowe CS, Sowder LL, Satterwhite T, Morrison SD. Staying on Top of Breast Implant Illness: An Analysis of Chest Feminization Experiences. Plast Reconstr Surg 2020; 145:885e-886e. [PMID: 32221263 DOI: 10.1097/prs.0000000000006691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kyle Latack
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Widya Adidharma
- Section of Plastic Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, N.Y
| | - Christopher S Crowe
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | | | | | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
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15
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Nolan IT, Blasdel G, Dubin SN, Goetz LG, Greene RE, Morrison SD. Current State of Transgender Medical Education in the United States and Canada: Update to a Scoping Review. J Med Educ Curric Dev 2020; 7:2382120520934813. [PMID: 32637641 PMCID: PMC7315660 DOI: 10.1177/2382120520934813] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/19/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND The published literature on education about transgender health within health professions curricula was previously found to be sporadic and fragmented. Recently, more inclusive and holistic approaches have been adopted. We summarize advances in transgender health education. METHODS A 5-stage scoping review framework was followed, including a literature search for articles relevant to transgender health care interventions in 5 databases (Education Source, LGBT Source, MedEd Portal, PsycInfo, PubMed) from January 2017 to September 2019. Search results were screened to include original articles reporting outcomes of educational interventions with a transgender health component that included MD/DO students in the United States and Canada. A gray literature search identified continuing medical education (CME) courses from 12 health professional associations with significant transgender-related content. RESULTS Our literature search identified 966 unique publications published in the 2 years since our prior review, of which 10 met inclusion criteria. Novel educational formats included interdisciplinary interventions, post-residency training including CME courses, and online web modules, all of which were effective in improving competencies related to transgender health care. Gray literature search resulted 15 CME courses with learning objectives appropriate to the 7 professional organizations who published them. CONCLUSIONS Current transgender health curricula include an expanding variety of educational intervention formats driven by their respective educational context, learning objectives, and placement in the health professional curriculum. Notable limitations include paucity of objective educational intervention outcomes measurements, absence of long-term follow-up data, and varied nature of intervention types. A clear best practice for transgender curricular development has not yet been identified in the literature.
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Affiliation(s)
- Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Gaines Blasdel
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Samuel N Dubin
- New York University Grossman School of Medicine, New York, NY, USA
| | - Laura G Goetz
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Richard E Greene
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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16
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Tijerina JD, Morrison SD, Nolan IT, Vail DG, Lee GK, Nazerali R. Analysis and Interpretation of Google Trends Data on Public Interest in Cosmetic Body Procedures. Aesthet Surg J 2020; 40:NP34-NP43. [PMID: 30810161 DOI: 10.1093/asj/sjz051] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several online resources such as Google Trends (GT) enable plastic surgeons to track search volume trends for cosmetic procedures. Understanding these data may allow surgeons to better anticipate patients' interests and meet their needs. OBJECTIVES The authors sought to evaluate the correlation between GT search volumes and annual surgery volumes. METHODS Search terms were generated using the "related queries" feature of GT. Data were obtained for the terms breast augmentation, buttock augmentation, buttock implants, buttock lift, calf augmentation, liposuction, lower body lift, thighplasty, abdominoplasty, and brachioplasty from January 2004 to November 2017. Annual volumes for respective procedures were obtained from statistics reports of the American Society of Plastic Surgeons (ASPS) from 2006 to 2017 and American Society of Aesthetic Plastic Surgery (ASAPS) from 2004 to 2017. Correlations were evaluated applying univariate linear regression of GT data to both ASPS and ASAPS data. RESULTS Geographical and temporal variations in search volume were detected during the study. Search volume trends that correlated significantly with both ASPS and ASAPS surgery volume trends were: "butt implants surgery" (ASPS: R2 = 0.366, P = 0.049; ASAPS: R2 = 0.380, P = 0.019); "liposuction" (ASPS: R2 = 0.690, P = 0.002; ASAPS: R2 = 0.578, P = 0.002); and "liposuction surgery" (ASPS: R2 = 0.672, P = 0.002; ASAPS: R2 = 0.476, P = 0.006). Several search terms demonstrated no significant relationships, negative correlations, or were significant with only one database. CONCLUSIONS This study characterizes GT as a convenient and informative data set for plastic surgeons to analyze patient interest in cosmetic body-sculpting procedures. GT represents a useful instrument for tailoring marketing strategies and addressing the needs of our patient population.
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Affiliation(s)
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Ian T Nolan
- New York University School of Medicine, New York, NY
| | - Daniel G Vail
- Stanford University School of Medicine, Stanford, CA
| | - Gordon K Lee
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Rahim Nazerali
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
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Tijerina JD, Morrison SD, Nolan IT, Parham MJ, Richardson MT, Nazerali R. Celebrity Influence Affecting Public Interest in Plastic Surgery Procedures: Google Trends Analysis. Aesthetic Plast Surg 2019; 43:1669-1680. [PMID: 31392394 DOI: 10.1007/s00266-019-01466-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Medical decisions made by celebrities have a profound influence on medical decisions made by the general population. Google Trends (GT) is a free, online resource with virtually no barriers to use that allows for tracking of global search volumes as a proxy for determining public interest. In this study, we utilize GT to characterize the significant and measurable effects that the May 2013 announcement of Angelina Jolie's BRCA-influenced prophylactic mastectomy, May 2015 announcement of Kylie Jenner's lip augmentation, April 2017 announcement of Caitlyn Jenner's gender affirming surgery and February 2014 media attention given to Kim Kardashian's rumored buttock augmentation had on corresponding surgical procedure volumes. METHODS GT databases of search volumes were collected for terms related to prophylactic mastectomy, lip augmentation, gender affirming surgery and buttock augmentation categories from January 2004 to March 2019 using the "related queries" feature. Mean search volumes prior to respective announcements were compared to that of the period starting 6 months after. Additionally, the percent change from the month preceding respective celebrity announcements was compared to the month of the announcement for each search term. RESULTS For mastectomy, all terms demonstrated peak interest during May 2013. Following Jolie's announcement, interest in "mastectomy" rose 1328%, "prophylactic mastectomy" rose 324%, "BRCA1" rose 316%, "BRCA2" rose 138% and "BRCA gene" rose 354%. Long-term interest was higher after May 2013 than beforehand for all terms except "prophylactic mastectomy" (each, p < 0.001). Following Kylie Jenner's announcement, interest in "lip augmentation" rose 43%, "lip enhancement" rose 37%, "lip fillers" rose 3233%, "lip implants" rose 8% and "lip injections" rose 13%. Long-term interest was higher after May 2015 than beforehand for all terms except "lip augmentation" and "lip enhancement" (each, p < 0.001). Following Caitlyn Jenner's announcement, "gender affirming surgery" rose 119%, "gender reassignment" rose 186%, "gender reassignment surgery" rose 203% and "transgender surgery" rose 35%. Long-term interest was higher after April 2017 than beforehand for all terms except "sex change" (each, p < 0.001). Following Kardashian's rumored injections, interest in "butt enhancement" rose 34% and "butt implants" rose 100%. Long-term interest was higher after February 2014 than beforehand for all terms (each, p < 0.001). CONCLUSIONS GT data trends correlate with shifts in real-world healthcare utilization and healthcare-related public interest caused by high-profile public events, making it a useful tool for real-time prediction of trends in public health in response to a variety of observable influences. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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18
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Boas SR, Ascha M, Morrison SD, Massie JP, Nolan IT, Shen JK, Vyas KS, Satterwhite T. Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery. Plast Reconstr Surg 2019; 144:1451-1461. [PMID: 31764668 DOI: 10.1097/prs.0000000000006282] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty. METHODS A retrospective chart review was performed of a single surgeon's experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed. RESULTS A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent). CONCLUSIONS Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Samuel R Boas
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Mona Ascha
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Shane D Morrison
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Jonathan P Massie
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Ian T Nolan
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Jacson K Shen
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Krishna S Vyas
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Thomas Satterwhite
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
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Cohen OD, Dy GW, Nolan IT, Maffucci F, Bluebond-Langner R, Zhao LC. Robotic Excision of Vaginal Remnant/Urethral Diverticulum for Relief of Urinary Symptoms Following Phalloplasty in Transgender Men. Urology 2019; 136:158-161. [PMID: 31790784 DOI: 10.1016/j.urology.2019.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the technique of robotic remnant vaginectomy/excision of urethral diverticulum in transmen and report postoperative outcomes. MATERIALS AND METHODS Between 2015 and 2018, 4 patients underwent robotic remnant vaginectomy/excision of urethral diverticulum for relief of urinary symptoms. Patients were of mean age 36 ± 10.1 years (range 26-50) at time of vaginal remnant excision, and were 26 ± 9.1 months (range 20-39) post-op following their primary vaginectomy and radial forearm free flap (n = 3) or anterolateral thigh (n = 1) phalloplasty. All had multiple urologic complications after primary phalloplasty, most commonly urinary retention (n = 4), urethral stricture (n = 3), fistula (n = 3), dribbling (n = 2), and obstruction (n = 2). Indication for revision was obstruction and retention (n =3 ) and/or dribbling (n = 2). In each case, the robotic transabdominal dissection freed remnant vaginal tissue from the adjacent bladder and rectum without injury to these structures. Concurrent first- or second-stage urethroplasty was performed in all cases at a more distal portion of the urethra using buccal mucosa, vaginal, or skin grafts. Intraoperative cystoscopy was used in each case to confirm complete resection and closure of the diverticulum. RESULTS At mean follow-up of 294 ± 125.6 days (range 106-412), no patients had persistence or recurrence of vaginal cavity/urethral diverticulum on cystoscopic follow-up. Of 3 patients who wished to ultimately stand to void, 2 were able to do so at follow-up. CONCLUSION Robotic transabdominal approach to remnant vaginectomy/excision of urethral diverticulum allows for excision without opening the perineal closure for management of symptomatic remnant/diverticulum in transgender men after vaginectomy.
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Affiliation(s)
- Oriana D Cohen
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Geolani W Dy
- Department of Urology, New York, University Langone Medical Center, New York, NY
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Fenizia Maffucci
- Department of Urology, New York, University Langone Medical Center, New York, NY
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Lee C Zhao
- Department of Urology, New York, University Langone Medical Center, New York, NY.
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20
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Affiliation(s)
- Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York
| | - Alexes Hazen
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle
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21
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Tijerina JD, Morrison SD, Nolan IT, Vail DG, Nazerali R, Lee GK. Google Trends as a Tool for Evaluating Public Interest in Facial Cosmetic Procedures. Aesthet Surg J 2019; 39:908-918. [PMID: 30304356 DOI: 10.1093/asj/sjy267] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The utility of Google Trends (GT) in analyzing worldwide and regional patient interest for plastic surgery procedures is becoming invaluable to plastic surgery practices. GT data may offer practical information to plastic surgeons pertaining to seasonal and geographic trends in interest in facial cosmetic procedures. OBJECTIVES The authors sought to analyze geographic and temporal trends between GT search volumes and US surgery volumes using univariate analysis. METHODS The "related queries" feature of GT generated potential search terms. GT data were compiled for cheek implants, mentoplasty, otoplasty, blepharoplasty, rhytidectomy, forehead lift, hair transplantation, lip augmentation, lip reduction, platysmaplasty, and rhinoplasty from January 2004 to December 2017. Annual volumes for respective procedures were obtained from annual statistics reports of the American Society of Plastic Surgeons (ASPS) from 2006 to 2017 and American Society of Aesthetic Plastic Surgery (ASAPS) from 2004 to 2017. RESULTS Geographical and temporal variations in search volume were detected during the study. Search volume trends that correlated significantly with both ASPS and ASAPS surgery volume trends were: "eyelid plastic surgery" (ASPS R2 = 0.336, P = 0.048; ASAPS R2 = 0.661, P = 0.001); "facelift" (ASPS R2 = 0.767, P ≤ 0.001; ASAPS R2 = 0.767, P = 0.001); "lip injections" (ASPS R2 = 0.539, P = 0.007; ASAPS R2 = 0.461, P = 0.044); and "rhinoplasty surgery" (ASPS R2 = 0.797, P ≤ 0.001; ASAPS R2 = 0.441, P = 0.01). Several search terms demonstrated no significant relationships or were significant with only one database. CONCLUSIONS GT may provide a high utility for informing plastic surgeons about the interest expressed by our patient population regarding certain cosmetic search terms and procedures. GT may represent a convenient tool for optimizing marketing and advertising decisions.
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Affiliation(s)
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Ian T Nolan
- New York University School of Medicine, New York, NY
| | - Daniel G Vail
- Stanford University School of Medicine, Stanford, CA
| | - Rahim Nazerali
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Gordon K Lee
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
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Abstract
Transgender and gender non-binary (TGNB) individuals are a growing demographic with unique healthcare needs. Amid changes in public and private insurance coverage of gender confirming surgeries (GCS), utilization of these procedures is increasing. Meanwhile, systemic barriers continue to limit access to gender confirming care and perpetuate health disparities among TGNB individuals. Studies on the prevalence of TGNB identities and utilization of GCS are limited by a lack of gender identity data in population-based surveys and electronic medical records. However, data collection on gender identity is improving, and will be essential for characterizing the healthcare practices and needs of TGNB individuals.
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Affiliation(s)
- Ian T Nolan
- School of Medicine, New York University, New York, NY, USA
| | | | - Geolani W Dy
- Department of Urology, New York University, New York, NY, USA
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Dy GW, Nolan IT, Hotaling J, Myers JB. Patient reported outcome measures and quality of life assessment in genital gender confirming surgery. Transl Androl Urol 2019; 8:228-240. [PMID: 31380229 DOI: 10.21037/tau.2019.05.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Transgender and gender nonbinary (TGNB) individuals may seek genital gender confirming surgery (GCS) as part of their transition. Outcomes of genital GCS may include gender congruence, sexual functioning and satisfaction, urinary symptoms, aesthetic satisfaction, and overall quality of life, among others. Despite a wide number of studies on results of vaginoplasty, metoidioplasty, phalloplasty, and other genital GCS, data regarding patient reported outcomes are limited. To date, there is no patient reported outcome measure (PROM) validated within the TGNB population to assess subjective outcomes of GCS. In this review, we aim to describe existing tools being utilized to report outcomes following GCS, assessing the merits and limitations of each.
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Affiliation(s)
- Geolani W Dy
- Department of Urology, New York University, New York, NY, USA
| | - Ian T Nolan
- School of Medicine, New York University, New York, NY, USA
| | - James Hotaling
- Department of Urology, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Department of Urology, University of Utah, Salt Lake City, UT, USA
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Rooker SA, Vyas KS, DiFilippo EC, Nolan IT, Morrison SD, Santucci RA. The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery. J Sex Med 2019; 16:661-672. [DOI: 10.1016/j.jsxm.2019.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
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Dubin SN, Nolan IT, Streed CG, Greene RE, Radix AE, Morrison SD. Transgender health care: improving medical students' and residents' training and awareness. Adv Med Educ Pract 2018; 9:377-391. [PMID: 29849472 PMCID: PMC5967378 DOI: 10.2147/amep.s147183] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. METHODS We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017. RESULTS Transgender health has yet to gain widespread curricular exposure, but efforts toward incorporating transgender health into both undergraduate and graduate medical educations are nascent. There is no consensus on the exact educational interventions that should be used to address transgender health. Barriers to increased transgender health exposure include limited curricular time, lack of topic-specific competency among faculty, and underwhelming institutional support. All published interventions proved effective in improving attitudes, knowledge, and/or skills necessary to achieve clinical competency with transgender patients. CONCLUSION Transgender populations experience health inequities in part due to the exclusion of transgender-specific health needs from medical school and residency curricula. Currently, transgender medical education is largely composed of one-time attitude and awareness-based interventions that show significant short-term improvements but suffer methodologically. Consensus in the existing literature supports educational efforts to shift toward pedagogical interventions that are longitudinally integrated and clinical skills based, and we include a series of recommendations to affirm and guide such an undertaking.
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Affiliation(s)
| | | | - Carl G Streed
- Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA
| | | | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY
| | - Shane D Morrison
- Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA
- Correspondence: Shane D Morrison, Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, 325 9th Avenue, Mailstop #359796, Seattle, WA 98104, USA, Tel +1 206 744 2868, Email
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