This Week in Plastic Surgery — May 21, 2026

Welcome to This Week in Plastic Surgery. This week we're covering 10 notable papers spanning innovations in breast reconstruction, the growing focus on patient-centered outcomes, new approaches in regenerative medicine, and risk stratification in trauma and burns. Let's dive in.

First, in breast reconstruction, two studies this week evaluate common adjuncts to implant-based procedures, focusing on both outcomes and safety. A report from the Mastectomy Reconstruction Outcomes Consortium, or MROC study, published in *Plastic and Reconstructive Surgery - Global Open*, evaluated the use of SurgiMend acellular dermal matrix, or ADM, in patients undergoing immediate two-stage subpectoral implant reconstruction [4]. Methods This was a prospective cohort study that applied an FDA-aligned statistical plan. It compared 119 patients who received SurgiMend to 868 who had reconstruction without ADM. The primary outcome was a composite of clinical success, defined as a minimal decline in BREAST-Q physical well-being scores at one year and no major complications within two years. Results After propensity-adjusted analyses, the investigators found that major complications were significantly lower in the SurgiMend group, at about 34% versus 47% in the control group. This translated to a significantly higher rate of composite clinical success for patients receiving the ADM, at 32% versus 21% for controls. The authors conclude that these findings support the safety and effectiveness of SurgiMend in postmastectomy reconstruction.

Complementing this, a study in the *Annals of Plastic Surgery* provides reassurance on the safety of another increasingly common adjunct: breast neurotization [9]. While early studies show promising sensory outcomes, the large-scale safety profile has been unclear. The Study This was a large, retrospective cohort study using the TriNetX Research Network, a nationwide database. The researchers identified over 35,000 patients who underwent immediate implant-based reconstruction. After propensity score matching, they compared 759 patients who had breast neurotization using a nerve allograft to 759 matched controls who did not. They looked at major complications at 6 months, 1 year, and 3 years. Conclusions The results were clear: there were no significant differences in the rates of major complications, including infection, explantation, or capsular contracture, between the neurotization and control groups at any time point. So, while the MROC study suggests an ADM may improve structural outcomes [4], this second paper provides strong evidence that adding a neurotization procedure to restore sensation doesn't appear to compromise safety by increasing complications [9].

Next, a major theme this week is the push to measure what truly matters to patients, with three papers using validated patient-reported outcome measures, or PROMs, in diverse clinical areas. A prospective study in the *Journal of Plastic, Reconstructive & Aesthetic Surgery* highlights the profound impact of facial feminization surgery, or FFS, for transgender and nonbinary individuals [1]. Using the validated FACE-Q PROM, investigators followed 65 patients before and after surgery. The results were striking. Satisfaction with overall facial appearance jumped from a baseline score of 34 to 92 at 12 months post-op. Similar massive gains were seen in social and psychological function. The authors also calculated the Minimal Important Difference, or MID, confirming these changes were not just statistically significant, but clinically meaningful to patients.

In a similar vein, a case series from *Plastic and Reconstructive Surgery - Global Open* evaluated the keystone perforator island flap for vulvar reconstruction in 14 patients, mostly for squamous cell carcinoma [5]. For the first time in this context, the study used the BODY-Q questionnaire to assess outcomes, finding a very high level of patient satisfaction. This demonstrates that the keystone flap is not only a safe and reproducible technique but also delivers excellent functional and aesthetic results from the patient’s perspective.

Rounding out this theme, a paper in *Burns* describes the development of a core outcome set for pediatric burn care, a key step toward value-based healthcare [2]. Rather than applying an existing PROM, the researchers used a modified Delphi study involving 60 caregivers and 81 professionals to reach consensus on what outcomes are most important. The final set includes 13 items, such as physical functioning, quality of life, pain, itchiness, mental health, and return to school. This work ensures that future research and quality improvement initiatives in pediatric burns will focus on endpoints that matter most to children and their families.

Shifting to the lab and early clinical studies, three papers explore novel ways to enhance tissue healing and survival. First, a rat model study in *Aesthetic Plastic Surgery* investigated adjuncts for improving fat graft retention [7]. Twenty rats were divided into four groups receiving fat grafts with either Botulinum Toxin Type A, G-CSF, both, or a control. The results were surprising. The group receiving only Botulinum Toxin showed significantly higher graft retention, better blood supply, and greater adipocyte viability. In contrast, the G-CSF group had increased inflammation and fibrosis, leading to reduced graft survival. There was no synergistic benefit when the two were combined. This suggests Botulinum Toxin may be a promising adjunct for fat grafting, while local G-CSF could be detrimental.

Also in *Aesthetic Plastic Surgery*, a murine model study explored the use of an acellular adipose matrix, or AAM, for wound healing [6]. This 'off-the-shelf' biomaterial, derived from human fat, was applied to full-thickness wounds on mice and compared to an antibiotic ointment control. The AAM-treated group showed significantly faster healing, with a mean closure time of 9 days versus 12 days for controls. Histology confirmed enhanced angiogenesis, or new blood vessel formation, in the AAM group. This positions AAM as a potential clinically applicable biomaterial for wound management.

Finally, a pilot study in *Plastic and Reconstructive Surgery - Global Open* brings this theme into the clinic [3]. Researchers evaluated electrical muscle stimulation, or EMS, in six older diabetic patients with lower extremity arterial disease who were on hemodialysis. These patients, often unable to perform conventional exercise, received EMS to their lower legs during dialysis sessions for eight weeks. The study found significant improvements in plantar flexion strength and, critically, in skin perfusion pressure. This suggests EMS is a feasible and potentially effective therapy to improve muscle strength and circulation in this very challenging patient population.

Finally, two studies this week help us better predict outcomes and counsel patients in challenging clinical scenarios. First, a large meta-analysis in *Plastic and Reconstructive Surgery - Global Open* examined predictors of mortality in over 37,000 older adult burn patients [10]. The study stratified patients into a 'younger-old' cohort, aged 60 to 79, and an 'older-old' cohort, aged 80 and up. As expected, the risk of death was significantly higher for those 80 and older. Total burn surface area, or TBSA, was a powerful predictor, with each increasing category of TBSA dramatically raising mortality risk. Flame burns were associated with nearly four times the risk of death compared to scald burns. Importantly, for management, surgical grafting was associated with a significant reduction in mortality compared to conservative management.

And in the *Journal of Reconstructive Microsurgery*, a retrospective review of nearly 6,200 shoulder trauma cases sheds light on the natural history of associated brachial plexus injuries [8]. The incidence of BPI was 1.8%, most commonly seen with fracture-dislocations. The axillary nerve was most frequently affected. While the good news is that about 75% of patients achieved complete recovery within a year, the study identified key predictors of poor outcome. Specifically, injury to the musculocutaneous nerve was strongly associated with reduced odds of recovery. This finding is critical for counseling patients and identifying those who may require more aggressive monitoring or intervention.

If you only have time for one paper this week, make it the Mastectomy Reconstruction Outcomes Consortium study on acellular dermal matrix in *Plastic and Reconstructive Surgery - Global Open* [4]. It provides some of the strongest evidence to date from a large, prospective cohort supporting the use of ADM to reduce complications and improve outcomes in two-stage implant reconstruction.

Here are the key takeaways from this week in Plastic Surgery. First: In implant-based breast reconstruction, evidence from the MROC study suggests using an acellular dermal matrix may reduce major complications and improve patient-reported outcomes [4]. Furthermore, a large database analysis indicates that adding nerve allograft neurotization for sensation does not appear to increase complication rates [9].

Second: For fat grafting, a preclinical study in *Aesthetic Plastic Surgery* suggests that Botulinum toxin can significantly enhance graft survival, while local G-CSF may actually be detrimental, increasing inflammation and fibrosis [7].

Third: In older adult burn patients, a meta-analysis confirms that age over 80, large TBSA, and flame burns are major predictors of mortality, while surgical grafting is associated with improved survival [10].

Fourth: Following shoulder trauma, be vigilant for brachial plexus injury, which occurs in nearly 2% of cases. While most patients recover, injury to the musculocutaneous nerve is a key predictor of poor recovery [8].

Fifth: Validated patient-reported outcome measures are becoming central to evaluating success. A study in *JPRAS* used the FACE-Q to demonstrate the profound, clinically meaningful improvements in quality of life and satisfaction after facial feminization surgery [1].

That's your roundup for This Week in Plastic Surgery. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.