Scientific Abstract Presentations: Practice Management / Surgical Pearls 3 Saturday, October 28 Sat, Oct 28 5:00-6:00 p.m. CDT

Purpose Physician productivity is a critical metric for both hospitals and practice plans, and accurate forecasting is needed to ensure adequate resource distribution. Forecasts are also used to set salaries and to aid in recruitment efforts. Physician productivity in academic health centers (AHCs) can be measured in a number of different ways, of which charges, cash collections, and work Relative Value Unit (wRVU) generation are the most common. From a practice perspective, wRVUs are a useful metric of productivity because they isolate physician work from payor mix and can capture a more holistic picture of a physician's contribution to the clinical enterprise. Hospitals and practice plans, which often budget and plan for a year but collect monthly data, most commonly use a naïve forecasting technique, in which the forecast for time t (Ft) is the actual value at t-1 (Yt-1). Another common method is to use the actual value from one year previously such that the forecast for time t (Ft) is the actual value at t-12 (Yt-12).

In this project, we use data from surgeons within a practice plan to answer two discrete questions: 1. What is the best forecast model for these data? 2. Can the same forecast model be used for different surgeons within a group, or must each surgeon have his own model?

Materials and methods We obtained deidentified surgeon-level RVU productivity for the past three years from a single Division within a Surgical Department. Data from January 2019 to April 2022 were used for three surgeons with different practice patterns. Statgraphics Centurian 19® was used for all analysis. To smooth monthly variation, the data were aggregated into quarterly data and quarterly data were used for analysis. The data were placed into time series plots and autocorrelations and periodograms were created. Regression analysis was performed for all time series plots. We modeled the data using exponential smoothing, simple linear regression, multiple regression, time series decomposition, and ARIMA. Each forecasting method was tested for randomness of residuals using runs above and below the median, runs up and down, and Ljung-Box test, as well as residual partial autocorrelations.

Results Exponential smoothing showed non-random residuals for surgeons C and H, and random residuals with a large variance for the surgeon F. Simple Linear Regression explained 60% of the variation in data for surgeon C, 17% for surgeon F, and 23% for surgeon H. Multiple Linear regression was not statistically significant or explained less than 50% of the variation in data for all surgeons. Time Series Decomposition was not an adequate model for surgeons without seasonality. ARIMA was a good model for surgeons with trend and seasonality.

Conclusions The appropriate forecast model is dependent on practice maturity, and naïve forecasting is likely inadequate. A seasonally-adjusted model is most appropriate for growing practices, and an ARIMA model is most appropriate for mature practices. Accurate forecasting models can help ensure adequate resource distribution and appropriate salary determinations.

INTRODUCTION: Microsurgical breast reconstruction is technically demanding, yet the learning curve is not well described. Various other surgical subspecialties have measured the learning curve of certain procedures and defining the learning curve for microsurgical procedures is especially important due to the high technical skill required. This study aimed to characterize the number of procedures required to master microsurgical breast reconstruction proficiently and efficiently.
METHODS: An institutional database was queried from 2006-2018 to identify all abdominally-based, breast free flaps performed by an experienced surgeon (ES) with almost 800 flaps prior to the beginning of the study period and a novice surgeon (NS) entering practice immediately post fellowship. The primary outcome was operative time and secondary outcomes were major/minor complications. Risk-adjusted cumulative sum curves were used to determine expected number of procedures required to attain optimal efficiency, defined as the peak of rapid improvement in operative duration. Linear regression was used to stratify complication rates by procedure number, while controlling for confounders. RESULTS: A total of 1,288 procedures with a mean of 393 minutes (SD 123) were identified for both surgeons. NS's operative time persistently decreased (-36.6 seconds/procedure, P<0.001) over the study period while ES was unchanged (P=0.353). There was no association between number of procedures and complications or partial/total flap loss (ES: P=0.423; NS: P=0.215). Greatest differential improvement in NS operative times was at approximately 300-350 procedures, 5 years post-training, while ES remained constant over the study period. CONCLUSIONS: Early microsurgical experience intimately correlates with reduced operative times and reaches a peak after completing 300 free flaps. Increases in efficiency do not compromise patient outcomes or safety of the procedure. Establishing a learning curve is important for breast microsurgeons to benchmark their progress and to create expectations for themselves after post-graduate training.

Purpose Cosmetic plastic surgery has been growing in demand and popularity, with a 22% increase in total surgical volume since 2000.[1] However, the racial demographic makeup of cosmetic surgery utilization does not proportionally represent that of the United States population, with underrepresentation found in African Americans and Hispanics.[2] This study evaluates whether microeconomic spending traits as a representation of financial stability can inform trends in cosmetic surgical and minimally invasive procedure volumes by racial group.

Methods Annual volumes for the top five cosmetic surgical procedures (breast augmentation, rhinoplasty, blepharoplasty, liposuction, and abdominoplasty) and top five cosmetic minimally invasive procedures (Botulinum toxin type A, soft tissue fillers, chemical peel, laser hair removal, and microdermabrasion) by racial/ethnic group from 2012-2020 were collected from the American Society of Plastic Surgeons' annual reports on plastic surgery statistics.[3] Using factor analysis to determine the consumer expenditure categories that shared the most common variation with other expenditures from the U.S. Bureau of Labor Statistics' (BLS) expenditure and income data by racial/ethnic groupings (White/Asian/Other, African American, Hispanic), food/medical services and entertainment were selected as proxies for the following microeconomic traits, inflexible and flexible consumer spending, respectively.[4] Additionally, average rates in both types of consumer spending, cosmetic surgical procedure volume, and minimally invasive procedure volume were calculated across the three BLS-defined racial/ethnic groupings and standardized so they could be interpreted relative to each other, with larger numbers indicating a larger mean difference.

Results Compared to the other groups, the White/Asian/Other grouping spent significantly more on average for inflexible consumer spending (estimate = 1.33, p = 0.0097), flexible consumer spending (4.38, p < 0.0001), cosmetic surgical procedures (6.36, p < 0.0001), and cosmetic minimally invasive procedures (2.58, p = 0.0006). In contrast, African Americans spent significantly less on average for inflexible consumer spending (-2.95, p = 0.0069), flexible consumer spending (-6.32, p < 0.0001), cosmetic surgical procedures (-10.04, p < 0.0001), and cosmetic minimally invasive procedures (-6.31, p = 0.0003). For Hispanics, values were significantly less on average for flexible consumer spending (-2.68, p = 0.0023), cosmetic surgical procedures (-6.86, p < 0.0001), and cosmetic minimally invasive procedures (-5.11, p = 0.0002).

Conclusions This study demonstrates that inflexible and flexible consumer spending follow trends in utilization of cosmetic surgical and minimally invasive procedures by racial/ethnic groups, with African Americans and Hispanics tending to spend less on consumer expenditures and having fewer cosmetic procedures done compared to their White and Asian counterparts. These microeconomic spending inequities may help further contextualize the racial/ethnic variation in access to cosmetic surgery.

References 1. Ullrich PJ, Garg S, Reddy N, et al. The Racial Representation of Cosmetic Surgery Patients and Physicians on Social Media. Aesthet Surg J. 2022;42(8):956-963. 2. American Society of Plastic Surgeons. Plastic Surgery Statistics Report: 2020. https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf. (n.d.). Accessed March 1, 2023. 3. Plastic Surgery Statistics. American Society of Plastic Surgeons. Updated April 27, 2021. Accessed December 20, 2022. https://www.plasticsurgery.org/news/plastic-surgery-statistics. 4. Consumer Expenditure Surveys. U.S. Bureau of Labor Statistics. Updated February 15, 2023. Accessed December 20, 2022. https://www.bls.gov/cex/tables.htm.

Purpose: While age, total body surface area (TBSA), and inhalation injury are established predictors of patient outcomes post-burn injury, the impact of urbanization levels remains unclear. This study aims to examine the association between urbanization levels and burn patient outcomes in the United States.

Methods: We performed a retrospective study using the 2019 National Inpatient Sample database. Patients with a primary diagnosis of burn or corrosive injury were included and categorized into 6 distinct groups based on their urbanization level, as determined by the 2013 Urban-Rural Classification Scheme. From the most urban to the most rural, the 6 groups were large central metropolitan, large fringe metropolitan, medium metropolitan, small metropolitan, micropolitan, and non-core counties. Elective admissions or patients aged <18 years were excluded. Patient and hospital characteristics were compared. Outcomes including in-hospital mortality, shock, prolonged mechanical ventilation, receiving surgery (skin graft), time to surgery, length of stay (LOS), and total costs were analyzed using multivariable linear and logistic regression models to determine the association between urbanization level and burn outcomes.

Results: A weighted population of 23,085 burn patients, among which 68% were male with mean age 48.9 years, were included. As urbanization level decreased, White race increased (38%-75%), while Black (27%-12%) and Hispanic populations (20%-4%) decreased (p<0.001). TBSA (p=0.006) and payer type (p<0.001) differed across urbanization levels, but there was no specific trend. Patients from large fringe metropolitan counties were the most likely to have higher income levels, while those from less urbanized counties had lower income levels (p<0.001). Comorbidity and inhalation injury were similar across groups. Most patients were admitted to urban teaching hospitals, with few patients admitted to rural hospitals except for micropolitan (11%) and non-core areas (10%). Patients from less urbanized counties had a slightly higher mortality rate (3% in large metropolitan and 5% in non-core areas), but the difference was not significant (p=0.139). Patients from large metropolitan areas had lower rate of shock compared to non-metropolitan areas (2-3% vs 4-6%, p=0.013). There were no differences in skin graft surgery, time-to-surgery, LOS, or total costs across urbanization levels. Compared to large central metropolitan counties, patients from less urbanized counties had lower odds of in-hospital mortality with adjusted odds ratios (aOR) ranging from 0.57 to 0.92, but these were not statistically significant. Patients from large fringe metropolitan [aOR: 1.81 (1.05-3.12), p=0.033], small metropolitan [aOR: 2.33 (1.15-4.72), p=0.019], and non-core counties [aOR: 2.75 (1.38-5.48), p=0.004] had significantly higher odds of shock, compared to large central metropolitan counties. Similar odds of prolonged mechanical ventilation and skin graft surgery were observed across groups. Compared to large central metropolitan counties, time-to-surgery was less in both small metropolitan counties [-0.71 days (-1.34 to -0.08), p=0.027] and micropolitan counties [-0.78 days (-1.54 to -0.02), p=0.044]. Despite highest total costs observed for non-core counties, the differences were not statistically significant.

Conclusion: After adjusting for patient and hospital characteristics, burn patients from less urbanized locations tended to have higher rates of shock during hospitalization. However, in-hospital mortality, morbidity, and resource utilization were similar across urbanization levels.

Introduction Panniculectomy is an elective but medically necessary procedure, and as such, there are important factors that contribute to patient choice that are not present in emergency procedures.1,2 Patient motivations for plastic surgery procedure are multifactorial, including medical, social, and financial considerations.3 This study aims to investigate the variation in out of pocket costs for patients undergoing panniculectomy procedures. Methods The IBM MarketScan Commercial Databases were queried to identify all patients who underwent outpatient panniculectomy in 2021, using CPT code 15830. Financial variables of interest included gross payments to the provider (facility and/or physician) and out of pocket costs (total of coinsurance, deductible, and copayments). Univariate parametric analysis was utilized to study the variation in financial variables across regions, insurance plan types, and places of service. Mixed-effects linear regression was utilized to analyze parametric contributions to total gross and out of pocket costs. Results The query identified 858 patients who had a panniculectomy in 2021. The majority of patients were female (88.8%), were in the South region (45.6%), had surgery in an on campus outpatient facility (82.2%), and had PPO insurance plan (49.9%). The majority of patients were in the 35-44 (35.9%) and 45-54 (33.7%) age groups. The overall median out of pocket cost was $117.71 (IQR $789.78). Out of pocket cost medians did not vary by region (p=0.457), but did vary significantly by insurance plan type (p=0.022) and by place of service (p=0.029). The highest median out of pocket cost was incurred in off campus outpatient facilities ($472.58, IQR $1,099.92) and the lowest median out of pocket cost was incurred in office facilities ($35.00, IQR $875.16). Mixed-methods regression revealed that insurance plan types contributed significantly to out of pocket costs. Comprehensive insurance plans contributed significantly to decreasing out of pocket costs (B = -$531.99, p=0.009), as did HMO plans (B = -$474.14, p=0.001), and PPO plans (B = -$266.71, p=0.020). Conclusion The out of pocket costs for panniculectomy procedures are variable depending on type of insurance plan and by place of service. The highest out of pocket costs are incurred in off campus outpatient facilities, and lowest were incurred in office facilities. For patients seeking panniculectomy, it may be in their best interest to obtain a comprehensive medical plan and seek services in an office facility. Plastic surgeons should be aware of these financial considerations as they approach joint decision making with patients.4,5 REFERENCES 1. Acarturk TO, Wachtman G, Heil B, Landecker A, Courcoulas AP, Manders EK. Panniculectomy as an adjuvant to bariatric surgery. Annals of plastic surgery. 2004 Oct 1;53(4):360-6. 2. Janis JE, Jefferson RC, Kraft CT. Panniculectomy: practical pearls and pitfalls. Plastic and Reconstructive Surgery Global Open. 2020 Aug;8(8). 3. Sterodimas A, Radwanski HN, Pitanguy I. Ethical issues in plastic and reconstructive surgery. Aesthetic plastic surgery. 2011 Apr;35:262-7. 4. Dirk T. Ubbink, MD, PhD, Trientje B. Santema, MD, MSc, Oren Lapid, MD, PhD, Shared Decision-Making in Cosmetic Medicine and Aesthetic Surgery, Aesthetic Surgery Journal, Volume 36, Issue 1, January 2016, Pages NP14–NP19, https://doi.org/10.1093/asj/sjv107 5. Myckatyn TM, Parikh RP, Lee C, Politi MC. Challenges and solutions for the implementation of shared decision-making in breast reconstruction. Plastic and reconstructive surgery Global open. 2020 Feb;8(2).

Background: Instagram has become one of the most powerful marketing tools available to plastic surgeons as patients have increasingly turned to online resources to find physicians.1 Instagram's easy to use interface and image focus provides an ideal conduit for patients reviewing surgical results online. Within, we review the online presence of self-ascribed plastic surgeons in the United States (US) to identify potential misinformation and dishonest advertising.

Materials and Methods: Institutional Review Board approval was not required as all data is publicly available. Inflact is an open access web-based marketing tool which was used to search all Instagram accounts, as queries through Instagram are limited to 60 results. Inflact was queried for the search terms: "plastic surgeon/surgery", "plastic and reconstructive surgeon/surgery", "aesthetic surgeon/surgery", and "cosmetic surgeon/surgery" producing 3,317 initial search results. Accounts were excluded if not in English, were not practicing in the US, were non-physicians, or were trainees. Account information, history of medical education and training, American Board of Plastic Surgery (ABPS) Certification status, and posts were reviewed. Descriptive statistics and independent samples t-tests were used with a predetermined level of statistical significance p<0.05.

Results: In total, 1,389 physicians practicing within the US were identified. Most attended medical school in the US (93%), a minority received integrated plastic surgery training in the US (16%), and the majority attended general surgery residency in the US (60%) followed by independent plastic surgery residency in the US (53%). Altogether, 1,125 individuals were explicitly listed as "plastic surgeons" on Instagram, nearly a third of these (28%) were not certified by the ABPS and 225 individuals (20%) received no training in plastic surgery. On average, non-board certified "plastic surgeons" had more followers than board-certified plastic surgeons (52,753 vs. 31,896, p=0.01)

A total of 172 facial plastic surgeons were found of which nearly half (49%) identified themselves as a "plastic surgeon", however only 11% trained in an independent plastic surgery residency. A total of 43 oculoplastic surgeons were identified, of which 45% identified themselves as a "plastic surgeon", while only one surgeon completed an independent plastic surgery residency. Interestingly, 101 individuals who were not plastic surgeons listed themselves as "aesthetic/cosmetic surgeons" and had residency training in a myriad of specialties including dermatology (16%), general surgery (30%), and obstetrics and gynecology (26%). Across all physicians identified, few offered information regarding costs of treatments (11%) while most advertised Botox and/or injectable treatments (91%).

Conclusions: There is an alarming number of individuals who mis-identify themselves as plastic surgeons on Instagram, as nearly a third of "plastic surgeons" on Instagram are not certified through the ABPS. This is detrimental to the reputation of plastic surgery and has the potential to create far lasting consequences, let alone patients mistakenly receiving care from unqualified physicians. The value of board certification has been previously discussed across a myriad of surgical fields.2 It is paramount that plastic surgeons create a united front against such endeavors through advocacy efforts within the American Society of Plastic Surgeons.

Background: Marijuana use is legalized for medicinal use in 37 states and recreational use in 21 states. Ongoing investigations of marijuana health impact require patient disclosure to healthcare providers, but patients may fear stigma or rejection from surgeons performing non-emergent procedures.

Methods: A retrospective chart review was performed for patients who received breast reductions from 2013-2022. Data collection included demographics, comorbidities, perioperative data, outcomes, and chart documentation of regular marijuana use. Patients were considered to have peri-operative marijuana use if regular use was clinically documented within a year of surgery. Exclusion criteria included tobacco use or breast cancer history. Statistical analysis included t-tests and Chi-squared tests.

Results: 413 patients underwent breast reductions over 9 years. 53 (12.8%) had regular marijuana use clinically documented within a year of surgery. 14 of 53 (26.4%) disclosed marijuana use to the surgeon performing their breast reduction. 39 disclosed use to non-surgeon providers, including pre-procedure anesthesia (15), obstetrics or emergency (14), and primary care or other provider. Patients had higher disclosure to surgeons after marijuana sale became operationalized instate (p=0.034), but disclosure did not increase after legalization, before instate sale. Patients using marijuana without disclosure to their surgeon demonstrated a higher pooled complication rate than patients who disclosed marijuana use to their surgeon (p=0.012).

Conclusions: Marijuana use disclosure to surgeons was lower than disclosure to other healthcare providers, predominantly specialties which emphasize social history screening. While patients may fear stigma from surgeons, it is likely that surgeons are not appropriately screening for marijuana use.

INTRODUCTION: In the current age of digital, patient-centered medicine, optimal care is defined not only by good clinical outcomes, but also by holistic patient wellbeing. The pursuit of this goal has been a driving force behind the philosophic shift to patient-reported outcomes (PROs) and development of high-quality patient-reported outcomes measures (PROMs). Plastic surgery helps patients by restoring or enhancing their form and function. Therefore, our discipline is uniquely aligned with patient-reported outcomes, and PROs are a vital tool for us to assess clinical practice. The authors sought to describe current common PROMs in plastic surgery, both generic and specific, including their validated populations, strengths, and limitations.

METHODS: We queried the most commonly used validated PROMs in PubMed between 2010 and 2022. Each PROM was classified into a field according to their respectively validation study. The number of publications using each PROM was determined using the top 20 plastic surgery journals according to H5-index between 2010 and 2022.

RESULTS: Thirty-three validated PRO instruments were included in our study that covered 12 specific sub-specialties within plastic surgery. Of the 33, 1 PROM was specific to breast, 1 was specific to aesthetic/body, 8 were specific to facial plastic surgery, 2 were specific to craniofacial, 2 were specific to abdominal wall, 4 were specific to upper extremity, 1 was specific to lower extremity, 2 were specific to chronic wounds, 3 were specific to scar, 3 were specific lymphedema, 1 was specific to gender, 2 were specific to migraine, and 3 were generic. The most referenced PRO Instrument was the BREAST-Q with 378 citations over the past 12 years. Following the BREAST-Q, the next four most commonly cited PRO instruments were the FACE-Q (169), Vancouver Scar Scale (144), Disabilities of the Arm, Shoulder and Hand (134), and Nasal Obstruction Symptom Evaluation (133). Three PROMs, the LYMPH-Q, WOUND-Q, and Wound-QoL have not been cited since their validation. As new forefronts in plastic surgery continue to emerge, more specific PROMs will be developed. For example, the GENDER-Q, a PROM focused on quantifying outcomes of gender affirmation surgery, has finished Phase I international field testing with two modules. Additionally, the LYMPH-Q for lymphedema currently only assess the upper extremity but will likely expand as lymphedema research progresses.

CONCLUSIONS: Our study found 33 specific PROMs that cover 12 sub-specialties within the plastic surgery literature. However, despite the plethora of PROMs available, only a few are cited regularly. As healthcare increasingly recognizes the value of PROs, there will be a shift towards systemic adoption. They will continue to expand to more sub-specialties and provide physicians knowledge about the patient experience that can be used to deliver more individualized, patient-centered care. We encourage plastic surgeons to utilize and incorporate the specific, validated PROMs available to their research and their practice.

PURPOSE: The purpose of this abstract is to utilize both graphic animation and annotated surgical video clips to highlight techniques in migraine surgery that our team has developed over the past five years.

PREOPERATIVE MARKINGS: After general anesthesia is induced, the patient is properly padded and placed onto the operating room table in prone position. The neck is trimmed a few centimeters above the occipital protuberance.

A vertical line is marked in the midline, thereafter a transverse line is marked on the back of the neck at the level of the occipital protuberance. A ruler is used to measure the lateral distance from the midline, and a tick mark is placed at the 5-cm and 7-cm mark. In our experience, the lesser occipital nerve has always been located below this area.

INITIAL DISSECTION: A 12-cm transverse incision is made 2 cm below this line at the occipital protuberance. We start by lifting a flap superiorly and inferiorly 2 cm in each direction leaving a 5 mm fat flap on the trapezius fascia. Then a 4x2 cm fat flap is raised on each side, based lateral to medial, which will be used later in the case to cushion the greater occipital nerve. The bilateral third occipital nerves are encountered, and they are usually severely entrapped in the trapezius fascia. The bilateral third occipital nerves are decompressed, transected, and buried into the muscle.

The dissection is directed 0.5 cm laterally from the median raphe. The dissection is continued deeper into the trapezius muscle and fascia until the vertical fibers of the semispinalis capitis muscle are identified.

DECOMPRESSING THE OCCIPITAL NERVES: The trapezius fascia is lifted, and the greater occipital nerves are identified. The semispinalis muscle is dissected around the nerve, and the segment of the muscle medial to the nerve 1 cm in length is separated from the midline raphe and transected. A triangular piece of the trapezius fascia and muscle fiber is removed laterally over the nerve. The nerve is further isolated with a spreading technique using a fine hemostat. The trapezius fascia over the nerve is incised, and the nerve is tracked laterally until it enters the subcutaneous fat. We then track the occipital nerve proximally down to the obliquus capitis muscle fascia. The occipital artery crosses over the greater occipital nerve. This artery is ligated. The lesser occipital nerve is identified. The nerve is tracked proximally until its exit from the posterior border of the sternocleidomastoid muscle. The nerve is transected and implanted into the sternocleidomastoid. This is repeated on the contralateral side.

FLAP CUSHION FOR THE GREATER OCCIPITAL NERVE: After hemostasis is achieved, the 4x2 cm fat flap that was raised earlier is now used to cushion the bilateral greater occipital nerves.

CLOSURE: The areas around the nerves are infiltrated with 40 mg kenalog. The deep subcutaneous layer is closed with 2-0 vicryl and 3-0 monocryl.

Objective. The US healthcare sector generates around 5.9 million tons of waste annually, accounting for 8% of the nation's carbon emissions. Final stages of waste disposal include landfilling or incineration of solid waste. Yet, a large portion of discarded medical waste includes recyclable material, such as silicone. In 2021, about 220,000 breast implant removals were performed,(1) and silicone implants accounted for 84% of breast augmentations performed the year prior.(2) Due to increasing demands for this product, the environmental impacts of its current disposal methods are considerable. We propose an alternative to landfilling and incineration of this resource as a novel initiative to improve medical waste management.

Methods. This is a pilot study of an institutional medical waste management initiative. After obtaining institutional environmental health services approval and risk management clearance, we collected previously explanted silicone breast implants. We decontaminated the implants using the institution's waste facility autoclave machine under 280 degrees Fahrenheit, at a pressure of 32 psi, for a 35-minute cycle. At our institution, all biohazardous waste is required to be autoclaved prior to disposal. The implants were then collected and packaged for air shipment to a specialized silicone recycling facility. We compared the carbon footprint of the recycled DMS-300 industrial grade silicone fluid produced from the implants versus the same quantity of fluid manufactured using prime materials. We also estimated the carbon footprint of the incineration and landfilling disposal pathway of the collected implants and that of the air-shipped package. We summed the carbon footprint of all the traditional processes and compared it to the summed carbon footprint of our proposed recycling pathway.

Results. A total of 43 implants were collected with a cumulative silicone volume of 20,55mL. After autoclaving, the implants remained intact, and their weight was unchanged. The estimated carbon footprint of the silicone fluid produced from the recycled breast implants is 257x10-4 MTCO2e (metric tons of carbon dioxide equivalent), while that produced from the manufacture of the same amount of silicone fluid using prime materials is 1197x10-4 MTCO2e. An estimated carbon footprint of traditional waste disposal options that include incineration and landfilling of our collected implants is 41x10-4 MTCO2e. Air shipment of the package from our location to the recycling facility emits an estimated 126x10-4 MTCO2e . Total carbon footprint of the recycling initiative pathway is 383x10-4 MTCO2e, a 70% decrease in total carbon footprint compared to the traditional pathway.

Conclusion. Recycling silicone breast-implants significantly reduces carbon footprint and is an effective ecological alternative to traditional waste disposal pathways. It also offers a sustainable route to the manufacture of industrial-grade material. Further large-scale analysis including national impacts and costs of each pathway is underway. As advocates of patient health and well-being, plastic surgeons should be conscious about the harms of current waste management practices and encourage innovative initiatives to promote lucrative and sustainable advancements.

1.The Aesthetic Society. Aesthetic Plastic Surgery National Databank Statistics 2020-2021. www.theaestheticsociety.org/media/procedural-statistics. Published 2021.

2.American Society of Plastic Surgeons. Plastic surgery statistics report. www.plasticsurgery.org/news/plastic-surgery-statistics. Published 2020.