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   

References

1. Bucky LP, Percec I, Del Vecchio DA. Fat Grafting in Plastic Surgery.

2. Coleman SR. Structural fat grafting. Plast Reconstr Surg. 2006.

3. 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 muscles

• High-risk zones: perioral (incompetence), neck (dysphagia), frontalis (ptosis)

• Used in 300+ conditions beyond aesthetics (hyperhidrosis, migraine, nerve injury)

1. Kane MA. Botulinum toxin. In: Grabb and Smith’s Plastic Surgery.

2. Scott AB, et al. Invest Ophthalmol Vis Sci. 1973.

3. Carruthers JD, Carruthers JA. Dermatol Surg. 1992.

4. 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 Takeaways

• High 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.

1. Barton FE. Skin resurfacing. In: Grabb and Smith’s Plastic Surgery. Chapter 41.

2. Study Guide – Analysis of Skin Resurfacing Techniques and Clinical Applications. Uploaded source document.

3. 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.

4. Hetter GP. An examination of the phenol-croton oil peel: Part I. Dissecting the formula. Plast Reconstr Surg. 2000;105:227.

5. Fitzpatrick RE, Rostan EF, Marchell N. Collagen tightening induced by carbon dioxide laser versus erbium:YAG laser. Lasers Surg Med. 2000;27:395.

6. 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 Takeaways

• Breast 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.

References

1. Latham 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.

2. 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.

3. 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.

4. 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 Takeaways

• Nipple 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.

References

1. Fuentes 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.

2. 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.

3. 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.

4. 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.

5. 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 Takeaways

• DIEP 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   

References

1. Nahabedian MY. Breast reconstruction: free flap techniques. In: Grabb and Smith’s Plastic Surgery. Chapter 62.

2. 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.

3. Keller A. Near-infrared spectroscopy for free flap monitoring. PMID/DOI not verified from provided materials.

4. 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 Takeaways

• Pedicled 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 #AutologousBreastReconstruction

References

1. 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. 2002;110(2):466-475.

2. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32:32.

3. Hartrampf CR, Scheflan M, Black P. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. 1982;96:216.

4. 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.

5. 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.

6. 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:

1. 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.

2. 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.

3. 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.

4. Joyce KM, Joyce CW, Jones DP, et al. Surgical Management of Melanoma. In: StatPearls [Internet]. 2017–. PMID: (see NCBI entry).

5. 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.

6. 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 #Residency

Links:🎧 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 :

1. Hammond DC, Loffredo MA. Latissimus Dorsi Flap Breast Reconstruction. In: [Chapter 60].

2. Rios J, Adams WP, Pollock T. Progressive tension sutures to decrease latissimus donor site seroma. Plast Reconstr Surg. 2003;112:1779.