Plastics in Practice (Resident Review)

Facial implants can dramatically change facial balance, but the difference between a natural result and an operated look comes down to planning, positioning, and fixation. In this episode, we break down the core principles of facial skeletal augmentation with implants for the plastic surgery resident. We review the major implant materials, the anatomic targets across the midface and mandible, and the operative concepts that matter most in real cases. This includes why subperiosteal placement is preferred, why screw fixation remains a key technical principle, and how to think through chin augmentation versus sliding genioplasty. We also cover common causes of poor outcomes, including malposition, asymmetry, poor transition zones, and technique-related complications rather than material toxicity. Key takeaways:Facial skeletal morphology is a major determinant of facial aestheticsAnthropometric normals are more useful than rigid neoclassical canons for planning Subperiosteal dissection improves visualization, precision, and safety during implant placement Screw fixation helps eliminate implant-bone gaps and reduces migration risk Infraorbital rim and paranasal implants can be powerful tools in midface deficiency Chin implants and sliding genioplasty each have distinct advantages and tradeoffs 🎧 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   ReferencesFarkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-338. doi:10.1097/00006534-198503000-00005. PMID: 3883374. Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997;100(5):1336-1353. doi:10.1097/00006534-199710000-00043. PMID: 9326803. Yaremchuk MJ, Israeli D. Paranasal implants for correction of midface concavity. Plast Reconstr Surg. 1998;102(5):1676-1684. doi:10.1097/00006534-199810000-00055. PMID: 9774030. Yaremchuk MJ. Infraorbital rim augmentation. Plast Reconstr Surg. 2001;107(6):1585-1592. doi:10.1097/00006534-200105000-00047. PMID: 11335841. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #PRS #FacialImplants #FacialSkeletalAugmentation #Craniofacial #Aesthetics #ResidentEducation #PlasticsInPractice

Prominent ears are not one deformity. They are usually a combination problem involving the antihelix, concha, and lobule. In this episode, we break down a practical, anatomy-first approach to otoplasty that helps you create a natural setback without a sharp, overdone, or obviously operated appearance.We review the major causes of auricular prominence, the aesthetic goals of correction, and the core maneuvers every plastic surgery resident should know. The focus is on reliable, cartilage-sparing principles: Mustarde sutures for antihelical recreation, Furnas sutures and selective conchal reduction for conchal excess, and deliberate management of the lobule so you do not leave behind a hockey-stick deformity. We also cover timing, infant ear molding, postoperative care, and complications worth respecting.Key TakeawaysProminent ears usually reflect a combination of underdeveloped antihelical fold, conchal excess, and lobule prominence. The goal is a soft, natural, harmonious setback with visible helical rim from the front and a straight helical contour from behind. Mustarde mattress sutures remain a foundational technique for recreating the antihelix. Furnas concha-mastoid sutures help address middle-third prominence by reducing the concha-mastoid angle. Lobule correction matters; ignoring it can leave a disharmonious result despite an otherwise good otoplasty. Early neonatal ear molding can permanently improve selected deformities without surgery. 🎧 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   ReferencesThorne CH, Wilkes G. Ear deformities, otoplasty, and ear reconstruction. Plast Reconstr Surg. 2012;129(4):701e-716e. doi:10.1097/PRS.0b013e3182450d9f. PMID: 22456385. Mustardé JC. Correction of prominent ears using buried mattress sutures. Clin Plast Surg. 1978;5(3):459-464. PMID: 359224. Furnas DW. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg. 1968;42(3):189-193. doi:10.1097/00006534-196809000-00001. PMID: 4878456. Gosain AK, Recinos RF. A novel approach to correction of the prominent lobule during otoplasty. Plast Reconstr Surg. 2003;112(2):575-583. doi:10.1097/01.PRS.0000071000.80092.2A. PMID: 12900617. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #Otoplasty #ProminentEar #AuricularDeformity #PlasticSurgeryResident #ResidentEducation #PRS #FacialPlasticSurgery #PediatricPlasticSurgery #SurgicalPearls

Rhinoplasty is not a reductive operation anymore. Modern rhinoplasty is about precision, preservation, and structure. In this episode, we break down a practical framework for analyzing the rhinoplasty patient, protecting the airway, and executing reproducible tip and dorsal maneuvers with fewer long-term problems. We cover the anatomy that actually matters in the OR: skin/soft tissue envelope behavior, the bony and cartilaginous vaults, the internal nasal valve, and the ligamentous support structures that determine projection, rotation, and long-term stability. We also walk through systematic nasofacial analysis, component dorsal hump reduction, algorithmic tip refinement, spreader graft logic, osteotomy planning, and why revision rhinoplasty remains so technically unforgiving. Key TakeawaysModern rhinoplasty favors conservative, structure-sparing techniques over aggressive resection. Component dorsal hump reduction helps preserve dorsal aesthetic lines and reduce midvault complications. Tip work should follow an algorithmic progression: cephalic trim, sutures, strut support, then grafting as needed. The internal nasal valve is a major determinant of airflow and must be protected throughout dorsal and septal work. Strong outcomes depend on methodical preoperative analysis and matching technique to deformity. 🎧 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   ReferencesGhavami A, Janis JE, Acikel C, Rohrich RJ. Tip shaping in primary rhinoplasty: an algorithmic approach. Plast Reconstr Surg. 2008;122(4):1229-1241. doi:10.1097/PRS.0b013e31817d5f7d. PMID: 18827660. Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg. 2002;109(3):1128-1146. doi:10.1097/00006534-200203000-00054. PMID: 11884847. Rohrich RJ, Ahmad J. Rhinoplasty. Plast Reconstr Surg. 2011;128(2):49e-73e. doi:10.1097/PRS.0b013e31821e7191. PMID: 21788798. Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg. 2004;114(5):1298-1308. doi:10.1097/01.PRS.0000135861.45986.CF. PMID: 15457053. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #Rhinoplasty #NoseJob #PlasticSurgeryResident #PRS #FacialAesthetics #SurgicalEducation #Residency #MedicalEducation #ENT #AestheticSurgery

Master the principles behind modern facelifting.This episode breaks down the core concepts of rhytidectomy, focusing on high-yield surgical principles, SMAS manipulation, and complication avoidance. We move beyond outdated skin-tension techniques and focus on what truly matters: volume restoration, anatomic precision, and hemodynamic control.You’ll learn how to think about facelifts like a surgeon—not just perform steps. From SMAS strategies to neck management and hematoma prevention, this is a practical, resident-level deep dive.Volume > tension: Excess skin tension leads to distortion and poor aestheticsSMAS is everything: Extended SMAS provides superior midface + neck correctionHematoma = #1 complication: Strongly linked to perioperative hypertensionAnatomy dictates safety: Stay superficial to the transparent fascia to protect CN VIINeck defines outcome: Platysma management is critical for cervicomental angleLess is more: Over-aggressive surgery → “operated” appearance🎧 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   BibliographyThorne CH. Facelift. Grabb and Smith’s Plastic Surgery.This content is for educational purposes only and is not medical advice.#PlasticSurgery #Facelift #SMAS #SurgicalEducation #PRS #Residency #Aesthetics #MedEd

Blepharoplasty looks simple—but it’s one of the easiest ways to create devastating complications if you don’t respect the anatomy.This episode breaks down the high-yield principles of modern blepharoplasty, focusing on what actually prevents bad outcomes: proper evaluation, conservative technique, and understanding lid support.We cover upper and lower lid strategy, when to preserve vs remove fat, and how to avoid classic complications like ectropion, scleral show, and retrobulbar hematoma.Evaluation is everything: vector analysis, lid laxity, and Schirmer’s test predict complicationsVolume preservation > aggressive excision to avoid hollow “A-frame” deformity Lower lid support is critical: canthopexy/canthoplasty reduces malposition risk Orbitomalar ligament release + fat redraping improves lid–cheek junctionRetrobulbar hematoma = emergency → immediate canthotomy/cantholysisTransconjunctival approach preferred in select patients to minimize complications🎧 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   Codner MA, Burke RM. Blepharoplasty. In: Plastic Surgery Text. Comprehensive Analysis of Modern Blepharoplasty. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #Blepharoplasty #Aesthetics #SurgicalPearls #PRS #Residency #Oculoplastics #FacialRejuvenation

The brow lift has evolved. What used to rely on long coronal incisions has shifted toward anatomically precise, minimally invasive endoscopic approaches designed to restore brow position while avoiding the over-elevated, unnatural “surprised” look.In this episode of Plastics in Practice, we break down the modern principles of forehead and brow rejuvenation with a resident-focused review of upper facial aging, brow aesthetics, relevant anatomy, retaining ligaments, and operative strategy. We cover how the frontalis acts as the sole brow elevator, why the corrugator, procerus, orbicularis, and depressor supercilii matter clinically, and how selective ligament release with controlled fixation helps produce more natural results.The frontalis is the only true brow elevator; the corrugator, procerus, orbicularis oculi, and depressor supercilii act as brow depressors.Female brows generally favor lateral elevation and arch, whereas the male brow should remain flatter and closer to the superior orbital rim.Over-elevating the medial brow creates the classic “surprised look” and should usually be avoided.The lateral retinacular ligament must be adequately released for effective lateral brow elevation.Modern endoscopic techniques reduce morbidity associated with traditional coronal approaches, including alopecia and paresthesia.Unicortical bone tunnel fixation provides durable suspension in endoscopic brow rejuvenation.🎧 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   #PlasticSurgery #BrowLift #ForeheadRejuvenation #EndoscopicBrowLift #AestheticSurgery #PlasticSurgeryResidency #FacialAesthetics #SurgicalEducationPhillips BZ, Hoy EA, Chang JT, Salomon JA, Sullivan PK. Forehead and brow rejuvenation. In: Thorne CH, ed. Grabb and Smith’s Plastic Surgery. 7th ed. Philadelphia, PA: Wolters Kluwer; chapter 45. Sullivan PK, Salomon JA, Woo AS, Freeman MB. The importance of the retaining ligamentous attachments of the forehead for selective eyebrow reshaping and forehead rejuvenation. Plast Reconstr Surg. 2006;117(1):95-104. doi:10.1097/01.prs.0000194904.27418.a0. PMID: 16404232.Disclaimer: This content is for educational purposes only and is not medical advice.

Fat grafting is no longer just filler—it’s a cornerstone of modern plastic surgery. In this episode, we break down the principles that actually determine graft survival, contour outcomes, and safety across facial and mega-volume applications.From the Coleman technique to BRAVA-assisted breast reconstruction, this is a high-yield, resident-focused deep dive into what matters in real cases.Fat graft “take” is ~40–60% → technique + vascularization are everything Small vs large volume = completely different strategies (micro-aliquots vs slurry + expansion) Best facial survival: deep, low-motion compartments (malar, cheek) Golden rule: V/C ratio ≤ 1:1 to avoid graft failure BRAVA pre-expansion ↓ interstitial pressure → ↑ volume capacity (up to ~700 cc) Biggest complications: overgrafting, contour irregularities, rare intravascular injection We cover donor site selection (spoiler: doesn’t matter much), processing methods (centrifugation vs sedimentation), and injection strategies (micro-aliquots vs mapping vs reverse liposuction). We also break down why irradiated tissue fails, how to stage reconstruction, and where stem cell enrichment currently stands (not FDA approved).🎧 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   ReferencesBucky LP, Percec I, Del Vecchio DA. Fat Grafting in Plastic Surgery.Coleman SR. Structural fat grafting. Plast Reconstr Surg. 2006.Coleman SR, Saboeiro AP. Fat grafting to the breast revisited. Plast Reconstr Surg. 2007.This content is for educational purposes only and is not medical advice.#PlasticSurgery #FatGrafting #SurgicalPearls #PRS #Aesthetics #Residency

Botulinum toxin is simple—until you actually try to use it well. This episode breaks down what most people get wrong: it’s not about units, it’s about functional anatomy and precision.We walk through the true mechanism (SNAP-25 cleavage → presynaptic blockade), why Botox affects nerves—not muscle or skin, and how that translates into real-world injection strategy. From glabella to platysma, this is a high-yield, resident-focused guide to getting consistent results while avoiding classic complications.If you’re still thinking in “standard dosing,” you’re already behind.BoNTA works via SNAP-25 cleavage → blocks acetylcholine release → functional denervation Effects are dose-dependent weakening, not paralysis—precision matters Functional anatomy > fixed dosing (e.g., Mona Lisa vs canine smile patterns) Most complications = toxin diffusion to adjacent musclesHigh-risk zones: perioral (incompetence), neck (dysphagia), frontalis (ptosis)Used in 300+ conditions beyond aesthetics (hyperhidrosis, migraine, nerve injury) Kane MA. Botulinum toxin. In: Grabb and Smith’s Plastic Surgery.Scott AB, et al. Invest Ophthalmol Vis Sci. 1973.Carruthers JD, Carruthers JA. Dermatol Surg. 1992.Kane MA. Plast Reconstr Surg.Disclaimer: This content is for educational purposes only and is not medical advice.🎧 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   #PlasticSurgery #Botox #Neurotoxins #Aesthetics #Residency #MedEd #FacialAnatomy #Injectables #CosmeticMedicine

Dermal fillers are more than just wrinkle tools. In this episode, we break down the science that actually drives filler performance: rheology, particle behavior, tissue planes, facial fat compartments, and complication management.This is a high-yield review of dermal and soft-tissue fillers for plastic surgery residents, fellows, and aesthetic surgeons. We cover how G′ (elastic modulus) and viscosity influence lift, spread, and extrusion; why cross-linking matters more than concentration alone for HA longevity; how facial aging reflects compartmentalized volume loss rather than uniform descent; and how these concepts translate into agent selection, injection plane, and technique. We also review the practical differences among HA, CaHA, PLLA, PMMA, collagen-based fillers, and fat, plus the major pearls in avoiding and managing vascular compromise, nodules, granulomas, and biofilm-related complications. This episode is grounded in the uploaded study guide and chapter source material. Key TakeawaysHigh G′ fillers provide more structural support and lift; lower G′ fillers suit more superficial, mobile areas.Cross-linking is a major determinant of HA durability and in vivo stability.Facial aging is compartmentalized, so strategic revolumization can create indirect correction of adjacent deformities.Injection pattern, plane, needle/cannula choice, and dilution should match the filler’s rheology and target anatomy. Complication readiness matters: vascular compromise requires early recognition and aggressive management, especially with HA products.References[1] Kablik J, Monheit GD, Yu L, Chang G, Gershkovich J. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg. 2009;35 Suppl 1:302-312. doi:10.1111/j.1524-4725.2008.01046.x. PMID: 19207319. [2] Sundaram H, Voigts B, Beer K, Meland M. Comparison of the rheological properties of viscosity and elasticity in two categories of soft tissue fillers: calcium hydroxylapatite and hyaluronic acid. Dermatol Surg. 2010;36 Suppl 3:1859-1865. doi:10.1111/j.1524-4725.2010.01743.x. PMID: 20969663. [3] Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219-2227. doi:10.1097/01.prs.0000265403.66886.54. PMID: 17519724. [4] Lemperle G, Rullan PP, Gauthier-Hazan N. Avoiding and treating dermal filler complications. Plast Reconstr Surg. 2006;118(3 Suppl):92S-107S. doi:10.1097/01.prs.0000234672.69287.77. PMID: 16936549. Disclaimer: This content is for educational purposes only and is not medical advice.🎧 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   #PlasticSurgery #DermalFillers #FacialRejuvenation #Aesthetics #PlasticSurgeryResidency #HyaluronicAcid #Sculptra #Radiesse #AestheticMedicine #MedicalEducation

Skin resurfacing is one of those topics that looks simple on the surface but gets very nuanced once you start thinking about depth, target tissue, endpoint recognition, and complication profile. In this episode, we break down the science of skin resurfacing in a way that actually matters for plastic surgery trainees.We cover the core anatomy behind resurfacing, why the dermal-epidermal junction matters, and how different modalities—chemical peels, dermabrasion, CO2 laser, Erbium:YAG, and fractional photothermolysis—produce different patterns of injury and healing. The real clinical question is not just what device or agent you use, but how deep you go, what problem you are treating, and what tradeoffs you accept. Wrinkle correction generally requires treatment through the DE junction into at least the papillary dermis, while deeper injury also increases the risk of scarring and permanent pigmentary change. Epidermal treatments target dyschromias, keratoses, and superficial actinic change.Wrinkle correction usually requires penetration through the DE junction into the papillary dermis.TCA, phenol/croton oil, dermabrasion, CO2, and Erbium:YAG all differ in mechanism, endpoint, and recovery.Fractionated resurfacing improves healing time by sparing intervening tissue, but may not match full-field CO2 for deep wrinkle effacement.Major complications include HSV reactivation, bacterial/fungal infection, hyperpigmentation, and permanent hypopigmentation.Barton FE. Skin resurfacing. In: Grabb and Smith’s Plastic Surgery. Chapter 41. Study Guide – Analysis of Skin Resurfacing Techniques and Clinical Applications. Uploaded source document. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426.Hetter GP. An examination of the phenol-croton oil peel: Part I. Dissecting the formula. Plast Reconstr Surg. 2000;105:227.Fitzpatrick RE, Rostan EF, Marchell N. Collagen tightening induced by carbon dioxide laser versus erbium:YAG laser. Lasers Surg Med. 2000;27:395.Karimipour DJ, Karimipour G, Orringer JS. Microdermabrasion: an evidence-based review. Plast Reconstr Surg. 2010;125:372.Disclaimer: This content is for educational purposes only and is not medical advice.🎧 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   #PlasticSurgery #SkinResurfacing #ChemicalPeel #LaserResurfacing #Dermabrasion #CO2Laser #ErbiumYAG #Aesthetics #MedEd #PlasticSurgeryResidency

Congenital breast anomalies are more than aesthetic diagnoses—they carry major psychosocial weight and demand a thoughtful reconstructive plan. In this episode, we break down the high-yield clinical framework for evaluating and surgically correcting congenital breast deformities, with a focus on tuberous breast deformity, developmental asymmetry, and Poland syndrome. This is the resident-level overview you actually want before clinic, consults, or conference: embryology, Tanner staging, classification systems, timing of intervention, and the operative principles that drive reconstruction. We cover why “improvement, not perfection” is the right counseling framework, why bilateral procedures are often necessary for symmetry, and how modern reconstruction increasingly incorporates fat grafting alongside implants, expanders, and autologous tissue transfer. Key TakeawaysBreast development begins in utero and matures through Tanner staging, with most definitive reconstruction delayed until breast maturity around ages 16–18.Tuberous breast deformity is defined by base constriction, lower-pole deficiency, high/tight IMF, parenchymal hypoplasia, and possible areolar herniation. Grolleau classification remains the practical system for tuberous breast deformity planning.Poland syndrome classically involves absence of the sternocostal head of pectoralis major with variable breast, chest wall, and upper-extremity anomalies. Reconstruction is individualized: implants, tissue expansion, latissimus flap, free tissue transfer, and adjunctive fat grafting all have a role depending on severity. The surgical goal is balanced form and symmetry—not perfection. ReferencesLatham K, Fernandez S, Iteld L, Panthaki Z, Armstrong MB, Thaller S. Pediatric breast deformity. J Craniofac Surg. 2006;17(3):454-467. doi:10.1097/00001665-200605000-00012. PMID: 16770181. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303. doi:10.1136/adc.44.235.291. PMID: 5785179. Grolleau JL, Lanfrey E, Lavigne B, Chavoin JP, Costagliola M. Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry. Plast Reconstr Surg. 1999;104(7):2040-2048. doi:10.1097/00006534-199912000-00014. PMID: 11149766. Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg. 2007;119(3):775-785. doi:10.1097/01.prs.0000252001.59162.c9. PMID: 17312477. Disclaimer: This content is for educational purposes only and is not medical advice.🎧 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   #PlasticSurgery #PRS #BreastReconstruction #TuberousBreast #PolandSyndrome #BreastAsymmetry #PlasticSurgeryResident #SurgicalEducation #MedEd #PlasticsInPractice

Nipple reconstruction is not the “small final step” of breast reconstruction—it is the focal point. A great breast mound can be undermined by poor nipple position, poor projection, or a mismatch in size and symmetry. In this episode, we break down the high-yield principles that actually matter when planning and performing nipple-areola complex reconstruction.We cover how to mark the nipple thoughtfully rather than relying on rigid measurements alone, why patient input matters more than many residents realize, and how technique selection changes depending on whether the breast mound is autologous or implant-based. We also review local flap options, contralateral composite grafting, cartilage and acellular dermal matrix strategies, and the role of tattooing as both an adjunct and a stand-alone option. Most importantly, we discuss the unavoidable issue of projection loss and why initial overcorrection is often the smarter move. Built from the uploaded chapter and study guide on nipple reconstruction. Key TakeawaysNipple position is the most unforgiving variable in NAC reconstruction and often matters more than the flap design itself. Local flaps remain the workhorse, especially in autologous reconstruction with adequate soft tissue. Expect projection loss over time; deliberate overcorrection is usually necessary. Prosthetic reconstruction often requires alternative strategies such as grafts, cartilage, ADM, or tattoo-only reconstruction. Tattooing is not just cosmetic finishing—it significantly affects final patient satisfaction. ReferencesFuentes PM, Langstein HN. A review of nipple-areola complex reconstruction and tattooing in postmastectomy breast reconstruction. Gland Surg. 2026;15(1):29-43. PMID: 41668920.Paolini G, Amoroso M, Pugliese P, et al. Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm. Aesthetic Plast Surg. 2021;45(3):933-945. doi:10.1007/s00266-020-02047-9. PMID: 33216178.Sisti A, Grimaldi L, Tassinari J, et al. Nipple-areola complex reconstruction techniques: A literature review. Eur J Surg Oncol. 2016;42(4):441-465. doi:10.1016/j.ejso.2016.01.003. PMID: 26868167.Smallman A, Smith M, Ramakrishnan V. Does nipple-areolar tattooing matter in breast reconstruction? A cohort study using the BREAST-Q. J Plast Reconstr Aesthet Surg. 2018. PMC7061635.Levy J, Bell DE, Winocour S, et al. Long-term nipple projection retention following local flap nipple reconstruction using 3D imaging. Plast Reconstr Surg Glob Open. 2025. PMID: 40677291.🎧 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   #PlasticSurgery #BreastReconstruction #NippleReconstruction #NACReconstruction #PRS #PlasticSurgeryResident #BreastSurgery #ReconstructiveSurgery #SurgicalEducation #PlasticsInPractice

Free flap breast reconstruction is one of the most technically demanding and rewarding procedures in reconstructive microsurgery. In this episode, we break down flap selection, donor-site strategy, recipient vessel choice, perfusion monitoring, and the key complications every plastic surgery resident needs to know.We focus on why the abdomen remains the preferred donor site for most patients, how DIEP, free TRAM, and SIEA differ in muscle preservation and vascular reliability, and when to move to secondary donor sites like SGAP, IGAP, or TUG/TMG. We also review why the internal mammary system is usually the recipient vessel of choice, how CTA/MRA improves preoperative planning, and how NIR spectroscopy and indocyanine green angiography can improve early detection of vascular compromise. Success in these cases is not just about anastomosis—it is about planning, judgment, and flap-specific decision making. Key TakeawaysDIEP offers strong abdominal wall preservation but requires meticulous perforator dissection.Free TRAM may improve perfusion while sacrificing more muscle than DIEP.SIEA avoids fascia violation but is anatomically feasible in only a minority of patients.Internal mammary vessels typically provide superior flow and positioning flexibility versus thoracodorsal vessels.CTA/MRA helps identify dominant perforators and streamline operative planning.Postop monitoring is critical, since early detection drives flap salvage. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #BreastReconstruction #FreeFlap #DIEPFlap #TRAMFlap #Microsurgery #ReconstructiveSurgery #PlasticSurgeryResident #SurgicalEducation #AutologousReconstruction🎧 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   ReferencesNahabedian MY. Breast reconstruction: free flap techniques. In: Grabb and Smith’s Plastic Surgery. Chapter 62.Nahabedian MY, Momen B, Galdino G, Manson PN. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. PMID/DOI not verified from provided materials.Keller A. Near-infrared spectroscopy for free flap monitoring. PMID/DOI not verified from provided materials.Colwell AS, et al. Near-infrared spectroscopy in free flap breast reconstruction. PMID/DOI not verified from provided materials.

Pedicled or free TRAM? This is one of the classic decision points in autologous breast reconstruction, and it still matters. In this episode, we break down the practical tradeoffs between pedicled TRAM, free TRAM, and DIEP-based thinking: flap perfusion, donor-site morbidity, operative complexity, and patient selection.For residents, this is the real question: when should you preserve muscle, when should you prioritize perfusion, and when is the “simpler” flap actually the smarter flap? We walk through the muscle-sparing classification, high-risk patient considerations, recipient vessel choices, and the aesthetic plus functional consequences that actually drive decision-making in the OR.Key TakeawaysPedicled TRAM prioritizes reliability, speed, and technical simplicity.Free TRAM offers improved perfusion and is often better for obese or heavy-smoking patients.DIEP minimizes muscle sacrifice, but fewer perforators can increase flap-related risk in selected cases.Larger flaps or smaller perforators may push decision-making toward muscle-sparing free TRAM rather than DIEP.Donor-site morbidity tracks closely with muscle and fascia sacrifice, but muscle preservation is not the only variable that matters.🎧 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.#PlasticSurgery #BreastReconstruction #TRAMFlap #DIEPFlap #Microsurgery #PRS #PlasticSurgeryResident #AutologousBreastReconstructionReferencesNahabedian MY, Momen B, Galdino G, Manson PN. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. 2002;110(2):466-475.Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32:32.Hartrampf CR, Scheflan M, Black P. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. 1982;96:216.Man LX, Selber JC, Serletti JM. Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review. Plast Reconstr Surg. 2009;124(3):752-764.Selber JC, Nelson J, Fosnot J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: part I. Unilateral reconstruction. Plast Reconstr Surg. 2010;126(4):1142-1153.Selber JC, Fosnot J, Nelson J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: part II bilateral reconstruction. Plast Reconstr Surg. 2010;126(5):1438-1453.

This long-form episode is a high-yield, start-to-finish in-service review. We cover the main topics: core principles → wounds/flaps/grafts → burns/skin cancer → CMF trauma + vision threats → hand infections/tendon zones → breast/implants + complications → trunk/LE coverage logic → last-minute algorithms.#PlasticSurgery #PSITE #InService #PlasticsInPractice #SurgeryResident #BoardPrep #Microsurgery #HandSurgery #Craniofacial🎧 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  References:Blumetti J, Hunt JL, Arnoldo BD, et al. The Parkland formula under fire: is the criticism justified? J Burn Care Res. 2008;29(1):180-186. PMID: 18182919. doi:10.1097/BCR.0b013e31815f3876. Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated ALCL. Aesthet Surg J. 2019;39(Suppl_1):S3-S13. PMID: 30715173. doi:10.1093/asj/sjy331. Hopkins PM, Rüffert H, Snoeck MMJ, et al. Malignant hyperthermia 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(5):655-664. PMID: 33399225. doi:10.1111/anae.15317. Joyce KM, Joyce CW, Jones DP, et al. Surgical Management of Melanoma. In: StatPearls [Internet]. 2017–. PMID: (see NCBI entry). Kennedy CD, Huang JI, Hanel DP. In Brief: Kanavel’s Signs and Pyogenic Flexor Tenosynovitis. Clin Orthop Relat Res. 2016;474(1):280-284. PMID: 26022113. doi:10.1007/s11999-015-4367-x. Safety Committee of Japanese Society of Anesthesiologists. Practical guide for management of systemic toxicity caused by local anesthetics. J Anesth. 2019;33(1):1-8. PMID: 30417244. doi:10.1007/s00540-018-2542-4.

Autologous reliability with prosthetic precision—the latissimus dorsi flap (LDF) is back for a reason. In this episode we break down how to optimize LD flap breast reconstruction using “volume-added” harvest and smart expander/implant strategy. We cover the operative setup from markings and skin paddle design to subfascial dissection to capture deep fat, high axillary tunneling, and inset strategies that improve contour while protecting the pedicle. We also clarify when to use expander as an intelligent spacer vs. immediate implant—and how Stage 2 refinement (4–6 months) improves final implant selection and symmetry.Key Takeaways:Markings: center the skin island on the muscle; align to relaxed skin tension lines to reduce ugly scars. Volume-added harvest: stay just under thoracic fascia to bring deep fat for better mastectomy-edge camouflage. Preserve lateral contour: respect the upper anterior “zone of adherence;” tunnel high in the axilla. Protect perfusion: keep serratus branch intact—critical collateral if thoracodorsal is compromised. Seroma is the enemy: quilting/progressive tension sutures + drains can reduce chronic drainage. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #BreastReconstruction #LatissimusDorsiFlap #Microsurgery #PRS #ResidencyLinks:🎧 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  References :Hammond DC, Loffredo MA. Latissimus Dorsi Flap Breast Reconstruction. In: [Chapter 60]. Rios J, Adams WP, Pollock T. Progressive tension sutures to decrease latissimus donor site seroma. Plast Reconstr Surg. 2003;112:1779.

Prosthetic breast reconstruction looks “simple” until you chase symmetry, fight the inframammary fold, and add radiation into the mix. This episode is a practical walkthrough of the two-stage expander–implant pathway—what actually matters, what fails, and how to plan it cleanly.Episode overviewWe cover patient selection, immediate vs delayed timing, modern biodimensional expanders, the expansion protocol, and the exchange operation with an emphasis on IMF positioning, inferior pole projection/ptosis, and strategies to optimize symmetry. We also break down ADM use (what it helps, what it costs), and why radiation changes complication risk and revision rates.Key takeaways:Ideal implant candidates: thin, bilateral, or thin unilateral with a nonptotic contralateral breast.Expansion pearls: start ~10–14 days, fill 30–120 mL per visit; overexpand ~25–30% to build skin for ptosis/projection.ADM: enables larger initial fills and pocket control, but can increase seroma and infection-related failure.Exchange: measure base width/height/projection; IMF definition is the highest-leverage step.Radiation: higher capsular contracture/complication rates—plan sequencing and counsel hard.LinksSpotify: 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/#PlasticSurgery #BreastReconstruction #Microsurgery #SurgicalEducation #Residency #TissueExpander #ImplantReconstruction #ADM #Oncoplastic #PRSReferences:Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions. Plast Reconstr Surg. 2010;125(6):1606-1614. PMID: 20517083. Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124(6):1772-1780. PMID: 19952633. Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2004;113(3):877-881. PMID: 15108879. Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. Influence of AlloDerm on expander dynamics/complications in immediate TE/I reconstruction. Ann Plast Surg. 2008;60(5):510-513. PMID: 18434824. Disclaimer: This content is for educational purposes only and is not medical advice.

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 #MastectomySpotify: 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.

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 takeawaysGynecomastia peaks in neonatal, adolescent, and >65 age groups—think T:E ratio shift. Pathology tracks duration: florid <4 mo, intermediate 4–12 mo, fibrous >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  

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 notchThe rationale behind the “snowman” skin resectionMedial vs superomedial pedicles and their impact on vascular reliability and sensationManagement of postoperative puckering and expectations for skin adaptationCommon pitfalls, including under-resection and premature revisionThis 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 tensionVertical techniques improve projection and base width compared to inverted-TMedial pedicles demonstrate the highest sensation recovery (~85%)Inferior puckering is expected and usually resolves without interventionPredetermined resection weights help avoid under-reductionDisclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #BreastReduction #VerticalMammaplasty #PRS #Residency #HallFindlay #SurgicalEducationHall-Findlay EJ. Vertical breast reduction. Plast Reconstr Surg. PMID: 12711950.Hall-Findlay EJ. Pedicles in vertical breast reduction. Clin Plast Surg. PMID: 15576215.