Level of Evidence in Plastic Surgery Research

Abstract There are limited studies in the plastic surgery literature that detail technical considerations in simultaneous breast implant removal and mastopexy procedures. These procedures are difficult, with significant potential for complications and poor cosmesis. The current plastic surgery literature describes a limited number of techniques that address these concerns, virtually all of which are variants of superior or superior medial pedicle vertical pattern mastopexy. This paper details a safe technique for simultaneous explantation and mastopexy with a novel open marking pattern and vertical bipedicle, which can restore breast cosmesis following implant removal. The study will briefly retrospectively review the results of a consecutive series of 86 patients who underwent this procedure from November 2018 to November 2019, with no incidence of partial or total nipple-areola complex necrosis. Thus, the technique is safe and allows the flexibility for intraoperative adjustments that are necessary for these procedures. A future study will conduct a more in-depth analysis of the results. Level of Evidence: 4

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Levels of Evidence in Rhinology and Skull Base Surgery Research

Otolaryngology ◽

10.1177/0194599820987131 ◽

2021 ◽

pp. 019459982098713

Author(s):

Jennifer A. Silver ◽

Marco Mascarella ◽

George Tali ◽

Rickul Varshney ◽

Marc A. Tewfik ◽

...

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Absolute Number ◽

High Quality ◽

Level Of Evidence ◽

Levels Of Evidence ◽

The Past ◽

Significant Difference ◽

Surgery Research ◽

Based Medicine

Objective The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade. Study Design Review article. Setting We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals. Methods The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2. Results In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 ( P < .001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant ( P < .001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ2 = 3.1, P = .077). Conclusion The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research.

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Evaluation of the Vertical Movement of Ribeiro’s Dermolipoglandular Mammary Flap One Year After Mammaplasties in Post-Bariatric Patients

Aesthetic Surgery Journal ◽

10.1093/asj/sjz188 ◽

2019 ◽

Vol 40 (1) ◽

pp. NP21-NP31 ◽

Cited By ~ 3

Author(s):

Rodrigo P Sizenando ◽

Marco Túlio C Diniz ◽

Paulo Roberto da Costa ◽

Luiz Gustavo S Manhães

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Plastic Surgery ◽

Breast Tissue ◽

Vertical Movement ◽

Level Of Evidence ◽

Significance Level ◽

Areola Complex ◽

Ptotic Breast ◽

One Year

Abstract Background In 1971, Ribeiro isolated a segment in the inferior pole of the ptotic breast, nourished by muscular perforating vessels, and moved it cranially to the posterior region of the remaining detached breast tissue, where it was fixed to the pectoral fascia. This maneuver created a flap with autologous implant function, independent from the rest of the breast’s support, that maintained long-term mammary projection. Objectives The objectives of this study were to measure the vertical movement of this flap 1 year after mammaplasty and to evaluate the factors involved. Methods The sample included 13 patients who had previously undergone bariatric surgery. The position of a titanium marker attached to the Ribeiro flap was compared on chest radiographs taken 1 day and 1 year after the mammaplasty. The significance level was set at 5%. Results All of the titanium markers moved 0.6 cm to 4.1 cm caudally during the study period (average, 2.4 cm ± 1.02 cm). The greater the weight loss after the plastic surgery, the further the marker’s descent. Weight loss between bariatric surgery and plastic surgery, the vertical dimension of the ptotic breast tissue immediately before plastic surgery, the vertical extent of the nipple-areola complex elevation during mammaplasty, the Ribeiro flap thickness and volume, and the breast volume after mammaplasty were not associated with the vertical movement of the flap. Conclusions The Ribeiro flap employed in mammaplasty of patients who previously underwent bariatric surgery undergoes ptosis that is exacerbated by weight loss after mammaplasty. Level of Evidence: 4

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