Scientific Abstract Presentations: Residents Aesthetic and Breast Abstracts Session 1 Friday, October 16 Fri, Oct 16 10:30 a.m.-12:30 p.m. CDT

Introduction Breast implant illness (BII) is a condition characterized by a wide array of systemic symptoms attributed by some patients to breast implants. BII remains a poorly understood clinical entity with limited biologic evidence of patient-reported systemic symptoms or identifiable tissue-level markers. Breast capsule tissue is a potential site of immune and inflammatory signaling and has been implicated in other breast-implant related conditions, however, its role in BII is unknown. This study aimed to evaluate transcriptional differences within breast capsules of patients with BII compared to asymptomatic controls using RNA-sequencing.

Methods Breast capsule specimens were collected from patients with breast implants undergoing implant removal and capsulectomy either with clinically-diagnosed BII symptoms without other identifiable cause or asymptomatic controls. Total RNA was extracted from capsule tissue, and samples were sent for library preparation and sequencing to Novogene Corporation where bulk mRNA-sequencing was performed. Differential gene expression analysis identified differentially expressed genes (DEGs) between groups (p<0.05). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify biologic processes implicated in differentially expressed genes. Protein–protein interaction (PPI) networks were constructed for the top 500 DEGs using the STRING database and visualized in Cytoscape, with network topology analyzed to identify hub genes and clusters.

Results RNA-sequencing demonstrated distinct transcriptional profiles between BII capsules (n=6) and control capsules (n=4). Differential expression analysis demonstrated 4544 up-regulated genes and 4416 down-regulated genes in BII capsules compared to controls. Enrichment analyses demonstrated significant up-regulation of genes involved in immune-related pathways, including immune response regulation, cytokine-cytokine receptor interaction, chemokine signaling, lymphocyte activation, and leukocyte adhesion (p<0.001). In contrast, there was a significant down-regulation of genes involved in metabolic pathways, including mitochondrial oxidative phosphorylation, aerobic respiration, and electron transport chain (p<0.001). The PPI network revealed several densely connected clusters, with the largest enriched for immune-related genes among up-regulated DEGs and mitochondrial/metabolic genes among down-regulated DEGs. Key hub genes, identified based on node degree, were CD4 and SYK for immune clusters with discrete chemokine ligand and HLA clusters, and MYL1 and MYL2 for metabolic clusters, highlighting central regulators within these functional modules. These findings indicate a coordinated activation of inflammatory signaling and concurrent depression of metabolic pathways with distinctly identifiable implicated pathway regulators in BII capsule tissue.

Conclusions Breast implant illness capsules exhibit a distinct transcriptional signature characterized by immune activation and metabolic depression compared to healthy control capsules. PPI analysis further supports that up-regulated genes in BII breast capsule tissue are functionally interconnected within immune pathways, whereas down-regulated genes form clusters associated with metabolic and mitochondrial processes, suggesting coordinated biological changes underlying disease pathogenesis. These findings suggest that in patients with symptomatic BII, there is a local, tissue-level chronic inflammatory pathophysiology in the disease state that is not present in asymptomatic patients. These novel findings not only provide validation for recognition of BII as a disease with a tangible biologic and clinical basis, but also provide a molecular foundation and potential targets for future investigations into the pathophysiology, identification, and treatment of BII.

Abstract: The landscape of obesity management has been transformed by the emergence of GLP-1 receptor agonists, leading to an exponential increase in massive weight loss (MWL) patients seeking body contouring surgery. While both bariatric surgery and pharmacotherapy achieve significant weight reduction, skin laxity sequelae affect up to 96% of patients, driving a surge in demand for reconstructive procedures. However, there is ongoing uncertainty and conflicting evidence regarding how these distinct metabolic and nutritional profiles influence surgical complication rates and wound healing, particularly when combined strategies are employed. This systematic review aims to synthesize and compare surgical outcomes and safety profiles of body contouring following GLP-1 therapy, bariatric surgery, and combined weight loss approaches. METHODS: A systematic search was conducted in PubMed, Scopus, and Google Scholar following PRISMA guidelines. Search terms included GLP-1 receptor agonists (semaglutide, liraglutide, tirzepatide) combined with body contouring and weight loss–related terms. Studies were screened based on predefined inclusion and exclusion criteria. Data on patient characteristics, type of weight-loss intervention, surgical procedures, and postoperative outcomes were extracted. Risk of bias was assessed using the ROBINS-I tool. Due to heterogeneity among studies, a qualitative synthesis was performed. RESULTS: A total of 12 studies comprising 236,402 pacients patients were included in the review, 8 studies were included in the metha-analysis. Procedures most commonly included abdominoplasty and panniculectomy, followed by other body contouring techniques. Interventions involved GLP-1 receptor agonists (semaglutide, liraglutide, tirzepatide), compared against non–GLP-1 patients and post-bariatric populations. In pooled analysis, GLP-1 use was associated with a significantly increased risk of wound dehiscence compared to non–GLP-1 patients (OR 2.60, 95% CI 2.10–3.21, p < 0.00001; I² = 39%). Conversely, when compared to bariatric surgery, GLP-1 use was associated with a lower risk of overall postoperative complications like seroma (OR 0.80, 95% CI 0.65–0.99, p = 0.04; I² = 15%). Narrative synthesis demonstrated heterogeneous findings, with some studies reporting increased wound complications, while others showed comparable or improved outcomes relative to bariatric cohorts. Combined GLP-1 and bariatric therapy was consistently associated with the highest complication rates. CONCLUTIONS GLP-1 receptor agonists are associated with an increased risk of wound complications compared to non–weight loss patients, yet demonstrate a comparatively lower risk of seroma than post-bariatric populations, suggesting an intermediate risk profile within the spectrum of weight loss modalities.

Background: Body contouring after massive weight loss carries high wound complication risk, making accurate preoperative risk assessment essential. BMI is commonly used to guide patient selection, yet it incompletely captures physiologic vulnerability and comorbidity burden. We evaluated whether a comorbidity-based physiologic model better predicts postoperative wound complications compared to BMI alone.

Methods: Adult patients undergoing panniculectomy, abdominoplasty, thighplasty, or brachioplasty were identified in the ACS NSQIP database from 2017 to 2024. The primary outcome was 30-day wound complication (SSI or dehiscence). Multivariable logistic regression models included a BMI-only model and a physiologic model incorporating BMI, ASA ≥3, CHF, steroid use, diabetes, smoking, and inpatient status. Model performance was assessed using area under the curve (AUC), Brier score, and net reclassification improvement (NRI), with 10-fold cross-validation.

Results: Among 29,379 patients included in our analysis, 7.4% developed postoperative wound complications. In the BMI-only model, BMI was associated with wound complications (OR 1.05 per unit, p<0.001). The physiologic model demonstrated improved discrimination (AUC 0.678 vs 0.656), improved risk classification (NRI 0.137), and higher identification of high-risk patients (67.8% vs 65.6%), with similar calibration (Brier 0.0657 vs 0.0665). Improvements were driven by incorporation of comorbidity burden rather than BMI alone.

Conclusion: BMI alone has limited ability to stratify risk in body contouring patients. A physiologic model incorporating comorbidities more accurately identifies patients at risk for wound complications. This supports moving beyond BMI-based thresholds toward more comprehensive, physiology-driven patient selection.

Introduction

Venous thromboembolisms (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are serious complications that may arise from any major surgery. The American Society of Plastic Surgeons updated guidelines for plastic surgeons on VTE in hospitalized patients in 2023.(1) However, guidance specific to body contouring procedures, increasingly performed on an outpatient basis, remains limited, and hesitancy amongst plastic surgeons about the balance between VTE and bleeding risk persists.(2)

Methods

A retrospective review of patients undergoing panniculectomy or abdominoplasty (PAB), bilateral brachioplasty (BBP), bilateral thighplasty (BTP), and bilateral mastopexy (BMP) at a single academic institution was conducted. Among the cohort, 274 patients underwent PAB, 67 patients underwent BBP, 30 underwent BTP, and 68 underwent BMP.

Data collected included patient demographics, Caprini scores, anticoagulation use, and outcomes, including bleeding events and 30-day rates of DVT and PE. Interprocedural comparisons were conducted across the four procedure groups, while intraprocedural analyses stratified patients by surgical burden (low vs high) based on operative time and the complexity of concomitant procedures. Non-parametric tests were used due to small sample sizes and non-normal distributions.

Results

History of VTE and preoperative Caprini score did not vary between the four groups. While perioperative anticoagulation did not vary, postoperative use did, with PAB having the highest proportion receiving anticoagulation and BTP the lowest (16.4% vs 0%, p < 0.001). In PAB, higher surgical burden was associated with more perioperative anticoagulation use (4.8% vs 0%, p = 0.008), but bleeding and VTE rates did not differ. In BTP, BBP, and BMP, surgical burden was not associated with differences in demographics, Caprini score, anticoagulation use, bleeding events, or VTE.

Bleeding events also differed by group, with the highest rate in the BTP group (16.7%) and the lowest in the BBP group (0%, p = 0.004). VTE events were uncommon across groups and did not significantly differ (range 0-3%, p = 0.244). BBP had the highest DVT rate (3.0%), and PE only occurred in the PAB group (0.7%).

Conclusions

VTE events were rare and did not differ by procedure despite variation in anticoagulation use, likely reflecting similar baseline risk and preoperative optimization. However, low event rates limit statistical power. Variation in anticoagulation use despite similar Caprini scores suggests procedural factors influence decision-making, highlighting a potential limitation of Caprini-based risk stratification in body contouring.

In contrast, bleeding complications varied significantly by procedure and were not explained by anticoagulation use alone, possibly indicating a stronger role for intrinsic procedural factors. These findings suggest VTE risk may be effectively mitigated through patient selection and procedural factors, highlighting the need for procedure-specific strategies to balance VTE prevention and bleeding risk.

References

1. Clavijo-Alvarez JA, Pannucci CJ, Oppenheimer AJ, Wilkins EG, Rubin JP. Prevention of venous thromboembolism in body contouring surgery: a national survey of 596 ASPS surgeons. Ann Plast Surg. 2011 Mar;66(3):228-32. doi: 10.1097/SAP.0b013e3181e35c64. PMID: 21200311; PMCID: PMC4505806.

2. American Society of Plastic Surgeons. Preventing venous thromboembolism in hospitalized plastic surgery patients. Arlington Heights (IL): American Society of Plastic Surgeons; 2023 Dec 15. Available from: ASPS VTE Practice Reference PDF

Introduction: Incisional care following abdominal contouring procedures presents unique challenges due to large, undermined flaps, tension-bearing closures, and fluid collection risks. An ideal postoperative dressing should promote wound healing, reduce bacterial burden, manage drainage, and optimize patient comfort. Although numerous dressing modalities are routinely used, comparative data specific to abdominal contouring surgery remain limited. This study evaluated the association between dressing type and postoperative complications following abdominoplasty and panniculectomy.

Methods: A single-institution retrospective review was conducted of patients undergoing abdominoplasty or panniculectomy. Patient demographics, comorbidities, operative characteristics, postoperative dressings, and complications were collected. Dressings included Sylke, Steri-Strips, Aquacel, and cyanoacrylate adhesives, which pooled Dermabond, Dermabond Prineo, and Histacryl to increase sample size. Major complications included reoperation. Minor complications included skin reaction, wound dehiscence, unsatisfactory scarring, dog ear deformity, hematoma/seroma, infection, and skin necrosis. Total complication rate was defined as the occurrence of ≥1 major or minor complication per patient within the study period.

Univariate analyses were performed to compare baseline demographic and operative characteristics across dressing groups. Continuous variables were analyzed using one-way analysis of variance (ANOVA), and categorical variables were compared using Pearson's chi-square test. Multivariable logistic regression models were constructed to predict postoperative complications. Backward stepwise elimination was performed to identify models with optimal Akaike Information Criterion (AIC). Model performance was evaluated using area under the receiver operating characteristic curve (AUROC), Hosmer–Lemeshow goodness-of-fit testing, and McFadden's pseudo-R².

Results: A total of 125 patients were included: 64 cyanoacrylate adhesives, 39 Sylke, 14 Aquacel, and 8 Steri-Strips. The mean age was 47.4 ± 11.0 years, 116 patients (92.8%) were female, and the mean BMI was 33.4 ± 6.5. Baseline demographic and operative characteristics did not differ significantly between groups.

On univariate analysis, Sylke was associated with lower rates of reoperation (0% vs 10.9%, p=0.043), total complications (15.4% vs 48.4%, p=0.001), skin reaction (2.6% vs 15.6%, p=0.049), wound dehiscence (5.1% vs 21.9%, p=0.046), and skin necrosis (0% vs 7.8%, p=0.014) compared to cyanoacrylate adhesives. No significant differences were observed between cyanoacrylate, Steri-strips, and Aquacel; however, comparisons were limited by smaller sample sizes.

On multivariable regression, Sylke independently predicted lower odds of total complications (OR 0.24, 95% CI 0.08–0.64, p=0.007) compared to cyanoacrylates, while increasing age was associated with higher odds (OR 1.05 per year, p=0.026). Model performance demonstrated good discrimination and calibration (AUROC 0.764, Hosmer–Lemeshow p=0.099, McFadden R²=0.202). Sylke was similarly associated with reduced odds of wound dehiscence (OR 0.17, 95% CI 0.03–0.73, p=0.034), with good model performance (AUROC 0.784, Hosmer–Lemeshow p=0.215, McFadden R²=0.202).

Conclusion: Cyanoacrylate-based adhesives were associated with significantly increased incisional complications compared to silk-fibroin dressings following abdominal contouring procedures. After multivariable adjustment, Silk-fibroin dressings remained independently associated with lower odds of total complications and wound dehiscence. Dressing selection may represent a modifiable factor in reducing wound complications in this high-risk population.

PURPOSE: Weight loss medications like glucagon-like peptide-1 (GLP-1) receptor agonists (RA) has drastically increased in popularity. Usage of medications has also emerged as a strategy for patients who have undergone bariatric surgery but struggled with weight loss plateau or weight regain. In body contouring, the combination of the two modalities may accelerate rapid weight loss and micronutrient deficiencies, potentially increasing the risk for surgical complications like poor wound healing and infection. In the current work, we compare postoperative outcomes following body contouring between post-bariatric surgery patients who are also on weight loss medications and those who are not.

METHODS: A retrospective cohort study of post-bariatric surgery patients who underwent body contouring at two public tertiary care centers from July 2022 to June 2025 was performed. The cohorts were stratified by the active use of weight loss medications within 30 days prior to contouring surgery. Postoperative complications included superficial/full thickness wounds, surgical site infection (SSI), seroma, hematoma, and hypertrophic/keloid scarring. Major complications including deep vein thrombosis/pulmonary embolism (DVT/PE), reoperation, and readmission were also examined. Post-bariatric surgery patients who were also on weight loss medications were compared to those who were not. Nearest-neighbor propensity score matching was used to match the two cohorts in a 2:1 ratio on covariates that were significant in univariate comparison.

RESULTS: 277 patients were included in the study, with a mean age of 45.3 and body mass index (BMI) of 30.6 kg/m2. The most common contouring procedure performed was panniculectomy or abdominoplasty (67.1%, n=186), followed by breast reduction or mastopexy (17.7%, n=49), brachioplasty (10.1%, n=28), thighplasty (4.7%, n=13), and back lift (0.36%, n=1). Of the total cohort, 39 patients (14.1%) were on weight loss medications, with most (n=34) being on GLP-1 RA. Compared to those who only underwent surgery, patients who were also on pharmacologic treatment had significantly older age (50.8 vs. 44.4), higher BMI (32.6 vs. 30.2 kg/m2), and higher prevalence of hypertension (41.0 vs. 24.4%) and diabetes (43.6 vs. 13.0%) (p<0.05). Following contouring surgery, the two cohorts had similar incidences of major complications (p>0.05). While the rates of seroma, hematoma, and hypertrophic/keloid scarring were comparable, patients who were on weight loss medications had significantly higher incidences of superficial wounds (10.3 vs. 2.94%, p=0.030), full thickness wounds or dehiscence (17.9 vs. 5.88%, p=0.008), and SSI (10.3 vs. 2.52%, p=0.016). After propensity score matching on age, BMI, hypertension, and diabetes (n=117), weight loss medication usage was associated with a significantly higher rate of full thickness wounds (17.9% vs. 3.8%, p=0.026) and similar rates of all other complications (p>0.05).

CONCLUSIONS: A significant subgroup of patients, 14% in our cohort, require weight loss medications even after bariatric surgery. In our propensity score-matched analysis, medication usage is found to be associated with a higher rate of dehiscence following body contouring, suggesting negative synergistic effects of pharmacologic weight loss and bariatric surgery on wound healing. Post-bariatric surgery patients who are also on weight loss medications should be appropriately counseled on the increased risk for poor wound healing following body contouring.

Background GLP1 receptor agonists (GLP1RAs) are increasingly prescribed to accelerate and sustain weight loss. These medications are often used after bariatric surgery to augment weight loss prior to body contouring. Whether the combination of bariatric surgery plus GLP1RA exposure carries an independent risk of post-operative wound healing complications after abdominoplasty, beyond the risk conferred by the magnitude of weight loss itself, has not been formally investigated.

Methods This study is a retrospective analysis of 120 abdominoplasty patients at a single academic institution from June 2022 to October 2025, stratified by pre-operative weight-loss mechanism (no massive weight loss, n=16; diet/exercise, n=12; GLP1RA alone, n=10; bariatric alone, n=52; GLP1RA + bariatric, n=30). Three outcomes were analyzed: seroma (n=23), wound healing complications (dehiscence or SSI, n=11), and all complications (n=32). Multivariable Firth-penalized logistic regression adjusted for weight on day of surgery, weight lost prior to surgery, age on day of surgery, and diabetes. The combined effects of GLP1RA and bariatric surgery on wound healing were then decomposed via (1) natural-effects causal mediation with weight lost to surgery as a mediator and 2,000 bootstrap resamples, (2) 1:1 propensity-score matching on pre-mediator covariates (24 pairs) with a stringent sensitivity match additionally balancing on weight lost (21 pairs), and (3) E-values for unmeasured confounding.

Results GLP1RA + bariatric patients had significantly higher rates of wound healing complications compared to bariatric surgery alone (26.7% vs 3.8%; crude OR 9.1, p = 0.005). This finding persisted after multivariable adjustment, including: natural-effects mediation (total OR 11.1, p_adj = 0.015), Firth-penalized logistic regression (OR 6.3, p = 0.027), and propensity score matching (OR 4.0, p = 0.063). The greater degree of weight loss in the combination GLP1RA + bariatric surgery group accounted for just 14% of the observed increase in wound healing complication rate (p = 0.040). E-values calculated to estimate unmeasured confounding range from 7.5–15.2, indicating moderate-to-strong robustness to unmeasured confounding. There was no effect of weight loss mechanism on seroma formation or overall complication rate.

Conclusions The combined effects of GLP1RA and bariatric surgery result in a significant direct increase in wound healing complications following abdominoplasty compared to GLP1RA or bariatric surgery alone that is not explained by the greater weight loss achieved in these patients. The finding is robust across three methodologically distinct analyses. However, the combined effects of GLP1RA exposure + bariatric surgery showed no significant increase in the complications within other complication categories. This data suggests that patients with a history of bariatric surgery and GLP1RA are at a higher risk of poor wound healing after abdominoplasty. Further pre-operative workup, such as a nutritional lab panel, may reveal the mechanism of this association and may allow for more effective prehabilitation of this patient population prior to abdominoplasty.

Introduction: Glucagon-like peptide-1 receptor agonist (GLP-1) use in both diabetic and non-diabetic populations has increased substantially in recent years, resulting in a growing number of patients presenting for body contouring procedures with concomitant GLP-1 use. Although these agents are generally considered safe, concerns remain regarding their potential effects on nutritional status and tissue quality (1), and their effect on surgical outcomes remains unclear. Prior studies have produced conflicting results, with some reporting higher rates of wound complications after body contouring in GLP-1 users (2, 3), while others found no increase in major postoperative complications (4,5). Therefore, this study aims to evaluate the association between preoperative GLP-1 use and postoperative complications following abdominoplasty and panniculectomy procedures utilizing a large, propensity-matched database.

Methods: A retrospective cohort study was conducted using the TriNetX Research Network-a global federated database of de-identified electronic health records. Patients who underwent abdominoplasty (CPT:15847, SNOMED:177250006) between 2006 and 2026 were isolated and stratified into two cohorts-those with documented GLP-1 use 90 days prior to surgery, and those without. Similarly, patients who underwent panniculectomy (CPT:15830) between 2006 and 2026 were isolated and stratified. For each procedure, the two cohorts underwent 1:1 propensity score matching for age, sex, obesity, diabetes, tobacco use, nicotine dependence, prior bariatric surgery status, and recent ventral hernia diagnosis. Postoperative outcomes of interest included surgical site infection, hematoma, seroma, wound dehiscence, necrosis, and overall postoperative complication rate. Outcomes were analyzed at 30, 60, and 90 days postoperatively.

Results: A total of 41,042 patients who underwent abdominoplasty were identified-565 with preoperative GLP-1 use within 90 days of surgery, and 40,477 without. Propensity score matching yielded 563 matched pairs that were used for subsequent analysis. 30-day outcomes of interest were comparable between cohorts, but preoperative GLP-1 use was associated with increased rate of wound dehiscence in the first 60 days (8.3% vs. 4.1%, p=0.003) and 90 days (9.1% vs. 5.0%, p=0.007) after abdominoplasty. Overall postoperative complication risk was also higher in the GLP-1 cohort in the first 60 days and 90 days postoperatively, but these did not reach statistical significance (p=0.050 and p=0.077, respectively). A total of 26,036 patients who underwent panniculectomy were also identified-1,203 with preoperative GLP-1 use within 90 days, and 24,833 without. Propensity score matching yielded 1,203 matched pairs. Preoperative GLP-1 use was associated with significantly increased risk of wound dehiscence within 30 days (5.9% vs. 3.9%, p=0.023). Wound dehiscence risk at 60-days and 90-days were also higher in the GLP-1 cohort, but these associations did not reach statistical significance (p=0.070 and p=0.064, respectively). Other postoperative complications were comparable between the two cohorts across all three timeframes.

Conclusions: Preoperative GLP-1 use was associated with an increased risk of wound dehiscence following both abdominoplasty and panniculectomy. These findings highlight the importance of careful perioperative assessment and optimization of individuals receiving GLP-1 therapy prior to body contouring procedures. Further prospective studies are warranted to clarify underlying mechanisms and guide perioperative management strategies in this growing patient population.

References: 1. Mehta M, Rometo D, Gusenoff J, Rubin JP. Nutritional Challenges in Post-Massive Weight Loss Body Contouring: Guidance for Plastic Surgeons on GLP-1 Agonists and Sleeve Gastrectomy. Plast Reconstr Surg. 2025 Dec 2. doi: 10.1097/PRS.0000000000012672. PMID: 41329155. 2. Lee CC, Newland M, Yau A, Chroneos R, Johnson TS. Impact of GLP-1 Agonist on Surgical Wound Complications Following Plastic and Reconstructive Surgery: A Propensity Matched Cohort Large Database Analysis. Plast Reconstr Surg. 2025 Dec 9. doi: 10.1097/PRS.0000000000012703. Epub ahead of print. PMID: 41364427. 3. Lewis JE, Ghogomu M, Hickman SJ, Ashade A, Hollis RJ, Lewis JE 3rd, Lee WC. Semaglutide and Postoperative Outcomes in Nondiabetic Patients Following Body Contouring Surgery. Aesthet Surg J. 2025 Mar 17;45(4):381-386. doi: 10.1093/asj/sjae241. PMID: 39665435; PMCID: PMC11913076. 4. Albanese R, Tomaselli F, Delia G, Tambasco D. GLP-1 Agonists in Aesthetic Surgery: Implications for Perioperative Outcomes and Body Contouring Procedures. Aesthetic Plast Surg. 2025 Sep;49(17):4910-4916. doi: 10.1007/s00266-025-05015-3. Epub 2025 Jul 2. PMID: 40603775. 5. Koenig ZA, Rashid S, Hobbs GR, Uygur HS. Perioperative GLP-1 Receptor Agonist Use and Surgical Outcomes in Nonbariatric Abdominal Panniculectomy: A 10-Year Retr

Patients with macromastia often have epigastric soft tissue fullness or laxity which is not addressed at the time of reduction mammoplasty. There is a variety of techniques described to combine reverse abdominoplasty with breast surgery, but it is mostly limited to reconstruction or augmentation of the breast. The technique presented involves a typical wise-pattern reduction mammoplasty followed by a limited reverse abdominoplasty. In this technique, the inframammary fold is preserved and incisions do not extend to midline, but rather remain as bilateral inverted T incisions typically seen with breast reductions. Intraoperatively, breast shape and symmetry are optimized with pillar sutures and mesh support, and the inframammary fold is reconstructed. Postoperatively, patients achieve improved upper abdominal contour with well-concealed scars and no major complications.This technique addresses previously unmet aesthetic concerns regarding upper abdominal fullness and laxity in patients with macromastia, providing a safe and effective solution to the problem.

Background: Breast reduction mammaplasty with free nipple grafting is used in patients with severe macromastia or when pedicled techniques are unlikely to safely achieve the desired breast size, but it is associated with complete postoperative loss of nipple-areola sensation. Reinnervation strategies have been described in other breast and chest procedures, although reports in free nipple graft reduction mammaplasty remain limited (1-3). We describe our technique and early clinical experience with intercostal nerve reconstruction during bilateral reduction mammaplasty with free nipple grafting. Methods: We performed a retrospective review of patients who underwent bilateral reduction mammaplasty with free nipple grafting and immediate intercostal nerve reconstruction. During the reduction, between one and three lateral intercostal nerves were identified on each side, depending on anatomy and tension. These donor nerves were coapted to a nerve graft using 8-0 microsuture, and the repair was protected with a nerve connector. Distally, the graft was splayed into fascicles, and multiple fascicles were sewn individually to the underside of the de-epithelialized nipple recipient site prior to free nipple graft inset. Results: Six patients underwent this technique between August 2025 and March 2026. Follow-up remains early. To date, patients have reported early return of sensation subjectively, although objective sensory testing has not yet been completed. No complications have been reported thus far, including nipple graft loss, neuroma, or revision related to the nerve reconstruction. Conclusions: Intercostal nerve reconstruction during free nipple graft reduction mammaplasty is a feasible sensory-restorative strategy that may help address one of the major functional drawbacks of free nipple grafting. Early clinical experience is encouraging, and longer follow-up with standardized sensory assessment is ongoing.

References Gfrerer L, Winograd JM, Austen WG Jr, et al. Targeted nipple-areola complex reinnervation in gender-affirming double-incision mastectomy with free nipple grafting. Plast Reconstr Surg Glob Open. Loughran AM, Hopkins JM, Hilt EK, Doshi K, Keith JD. Direct neurotization of free nipple grafts following mastectomy for gender-affirming surgery. Microsurgery. Ahmed OA, Kolhe PS. Comparison of nipple and areolar sensation after breast reduction by free nipple graft and inferior pedicle techniques. Br J Plast Surg.

Purpose:
Autologous free flap breast reconstruction is a commonly performed option for breast reconstruction following mastectomy. More recently, surgeons have used autologous tissue for breast augmentation including contralateral symmetrizing augmentations and primary breast volume enhancement or following failed implant augmentation. We aimed to provide a systematic review of the use of autologous reconstruction for breast augmentation to elucidate the evolving use of free flaps to the breast and to identify their emerging indications.

Methods: We searched PubMed to identify studies describing breast augmentation with autologous reconstruction. Key search terms included "DIEP augmentation" and "free flap breast augmentation." Two examples of autologous breast augmentation performed at author's institution are reviewed.

Results: We identified seventeen articles total describing free flap autologous reconstruction (141 patients, 203 breasts), of which six articles (61 patients, 56 breasts) described autologous reconstruction for contralateral augmentation only. Indications for aesthetic augmentation in the remaining articles include: body contouring after massive weight loss, prior failed implant augmentation, volume restoration, congenital asymmetry, gender dysphoria, and breast hypoplasia. Autologous free flaps were performed using DIEP, SIEA, SCIA, LTAP, infragluteal, SGAP, TUG, and PAP flaps for augmentation of a total of 203 breasts. Anastomoses were performed to ipsilateral internal mammary vessels/perforators (120 breasts), ipsilateral thoracodorsal vessels (31 breasts), or tunneled to the contralateral side for anastomosis to the contralateral internal mammary vessels (13 breasts) or side branches to a contralateral flap pedicle (39 breasts). For 33 breasts in which contralateral vessels were utilized for anastomosis, flaps were tunneled under the skin across the chest with no incisions made to the augmented breast. Eight women who underwent massive weight loss had mastopexy with Wise pattern skin incision performed at the time of autologous flap transfer, others had staged mastopexy performed in subsequent operation. Total flap loss occurred in 1.5% of flaps. The remainder of acute complications include donor site complications, wound healing delays, and salvageable flap complications requiring return to the OR for anastomosis revision.

Conclusion:

Surgeons have successfully expanded the utility of autologous free flaps to the breast beyond primary breast reconstruction. This literature review reveals a variety of indications for autologous free flap breast augmentation. Surgical techniques described offer new advantages to augmentation including obviating increased scar burden in the setting of contralateral reconstruction by cross-chest tunneling of the augmenting flap. Additionally, performing concomitant mastopexy at the time of autologous free flap-based breast augmentation offered a single-stage approach for volume enhancement and reshaping of the ptotic breast. Available studies indicate significant complications after autologous augmentation were rare, although revision surgeries were often pursued. Patients hoping to avoid implant-based augmentation may benefit from autologous flap-based augmentation.

Background Reduction mammaplasty alleviates the physical and psychosocial burden of macromastia. Elevated body mass index (BMI) is often cited as a risk factor for postoperative morbidity, yet its independent effect remains unclear.

Methods A retrospective review of 952 patients (1,904 breasts) undergoing bilateral reduction mammaplasty by a single surgeon (2002-2024) was performed. Patients were stratified into World Health Organization BMI categories. Outcomes of interest included minor (not requiring readmission or reoperation) or major (requiring readmission or reoperation) complications. Logistic regression analyses were conducted, adjusting for diabetes, hypertension, smoking (active or prior), and prior radiation.

Results The mean BMI was 34.0 (17.85-72.6). Overall, 278 (29.2%) patients experienced complications: 153 minor and 125 major. Minor complications increased stepwise with BMI (normal weight 4.7% vs obesity class III 31.2%, p<0.001). On multivariable analysis, obesity class II (OR 2.67, 95% CI 1.19–6.82) and class III (OR 3.40, 95% CI 1.50–8.80) independently predicted minor complications. BMI was not independently associated with major complications. Instead, hypertension (OR 1.70, 95% CI 0.99- 2.86, p=0.05), active smoking (OR 2.13, 95% CI 1.08-3.98, p=0.02), and prior smoking (OR 2.94, 95% CI 1.04-7.27, p=0.03) predicted major complications.

Conclusion BMI independently predicts minor wound-related complications but not major complications. Major morbidity is more strongly influenced by comorbidities such as hypertension and smoking. These findings support individualized risk assessment and comorbidity optimization rather than rigid BMI cutoffs when counseling patients for reduction mammaplasty.

Background: The inverted-T reduction mammaplasty, first described by Wise (Wise, 1956), remains one of the most widely utilized techniques for the management of macromastia. Despite its reliability and subsequent refinements in pedicle design, including the vertical dermal flap (McKissock, 1972), limitations including inframammary scar visibility and lateral dog-ear formation persist. Although individual technical modifications to the inframammary limb have been described in the literature (Colohan, 2020), no prior study has integrated multiple refinements into a unified approach. We describe a novel combination of three complementary modifications designed to optimize contour and scar aesthetics.

Methods: A modified approach to the inverted-T technique was developed incorporating three key elements: (1) a curvilinear ("inverted arch") configuration of the inframammary incision to better conform to the native breast footprint, (2) strategic placement of the inferior limb slightly below the inframammary fold to account for postoperative settling and optimize long-term scar position, and (3) controlled dermal pleating during closure to redistribute excess skin and minimize dog-ear deformities (Hall-Findlay, 2004). These principles have been applied in over 20,000 bilateral reduction mammaplasty procedures using standard pedicle techniques.

Results: Application of these refinements resulted in improved inframammary contour, reduced lateral fullness, and enhanced scar positioning along the inframammary fold. Intraoperative dermal pleating facilitated controlled redistribution of skin redundancy, obviating the need for additional excisional maneuvers. No increase in operative time or complication rates was observed.

Conclusion: This study presents a novel, integrated refinement of the classic Wise pattern, combining three previously described but independently applied techniques into a single reproducible approach. By emphasizing curvilinear incision design, strategic scar placement, and tailored closure, this method aligns with modern principles of breast shaping (Spear, 2003) and may improve aesthetic outcomes while preserving the safety and versatility of the inverted-T technique.

References: 1. Wise RJ. A preliminary report on a method of planning the mammaplasty. Plast Reconstr Surg. 1956;17(5):367–375. 2. McKissock PK. Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg. 1972;49(3):245–252. 3. Colohan SM, Massenburg BB, Gougoutas AJ. Breast reduction: surgical techniques with an emphasis on evidence-based practice and outcomes. Plast Reconstr Surg. 2020;146(3):339e–350e. 4. Hall-Findlay EJ. Vertical breast reduction. Semin Plast Surg. 2004;18(3):211–224. 5. Spear SL, Howard MA. Evolution of the vertical reduction mammaplasty. Plast Reconstr Surg. 2003;112(3):855–868.

Purpose: Autologous reconstruction using Deep Inferior Epigastric Perforator (DIEP) flap remains as a mainstay in breast cancer care. For postoperative analgesia, the transversus abdominus plane (TAP) block is a common option. Recently, Quadratus lumbar (QL) blocks has emerged as an alternative pain control for lower abdominal surgeries. Our study aimed to compare the efficacy of TAP block versus QL block on the quality of recovery in DIEP flap-based breast reconstruction.

Method: This is a double-blind randomized controlled trial. Patients undergoing breast reconstruction with DIEP flaps were included in the study. Quality of Recovery-15 (QoR-15) survey was used for patient satisfaction scores, and visual analog scales and post-operative analgesic use was collected. Chi-square and t- tests were utilized to examine categorical and continuous variables respectively.

Results: 46 participants were included in the study and randomized to the TAP and QL block arms. There was statistically significant improvement in mean QoR-15 scores in the QL group in comparison to the TAP group (84.09 vs 94.09, p = 0.04). Total oral morphine equivalents were significantly decreased in the QL group (227.5mg vs 135.1mg, p = 0.04). Visual analog scores were similar in both groups up until the 16th hour scores, where there's statistically significant increase in pain scores in the TAP group (3.67 vs 1.91, p = 0.005 at the 16th hour, and 3.64 vs 1.82, p = 0.001 24th hour).

Conclusions: Overall, our study proves that the QL block is superior to the TAP block on post-operative recovery and pain control in patients with DIEP flap-based breast reconstruction. Further larger scale, multi-center based RCT study is planned to better elucidate the application of the QL block in such type of breast reconstruction.

Capsular contracture is one of the most common complications of breast augmentation, with reported rates of up to 20%, and may mimic a restrictive ventilatory pattern due to scarring and fibrosis of the chest wall (1). However, the impact of its surgical treatment on objective ventilatory parameters remains largely unknown (2). This study aimed to evaluate the effect of implant removal and capsulectomy on spirometric parameters.

A prospective, single-center, observational analytic study was conducted. Consecutive non-probability sampling was performed from October 2024 to May 2025. Patients with capsular contracture and indications for surgical management were included. Implant removal with total capsulectomy was recommended, and informed consent was obtained. Baseline variables were recorded. A standardized preoperative evaluation was performed according to institutional guidelines. Each patient was assigned a surgical date. Using this date as a reference, two pulmonary function assessments using standard spirometry (3) were scheduled: the first 3 weeks preoperatively and the second 4 weeks postoperatively. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratio were recorded. Pre- and postoperative values were compared using a paired t-test.

Thirty patients met inclusion criteria. Mean age was 53.3 years (SD 8.3). FVC increased from 3.32 ± 0.53 L to 3.44 ± 0.50 L (p = 0.0028), and FEV1 from 2.62 ± 0.52 L to 2.76 ± 0.49 L (p = 0.0019). No significant changes were observed in the FEV1/FVC ratio.

Implant removal with capsulectomy in patients with capsular contracture is associated with a measurable improvement in pulmonary function, as evidenced by increased FVC and FEV1. These findings support the notion that implant-related and/or capsule-related factors may contribute to pulmonary impairment consistent with a restrictive pattern. Prior studies (1) reported similar findings, identifying a restrictive, non-obstructive spirometric pattern in this population; however, the underlying mechanisms remain incompletely understood. This study highlights a potentially underrecognized functional consequence of capsular contracture beyond pain and aesthetic deformity and reinforces the need for further investigation into its pathophysiology and clinical impact.

References 1. Wee CE, Younis J, Boas S, Isbester K, Smith A, Harvey DJ, et al. The objective effect of breast implant removal and capsulectomy on pulmonary function. Plastic and Reconstructive Surgery - Global Open 9(6):p e3636, June 2021. 2. Wee CE, Younis J, Isbester K, Smith A, Wangler B, Sarode AL, et al. Understanding Breast Implant Illness, Before and After Explantation: A Patient-Reported Outcomes Study. Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S82-S86. 3. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019 Oct 15;200(8):e70-e88.

Breast reshaping is one of the most requested procedures after massive weight loss (MWL). Implant-based mastopexy restores volume and projection but may increase complication rates because of compromised tissue quality. Autologous mastopexy avoids implant-related risks but has its own limitations. Direct comparative data in post-bariatric patients remain scarce.

A retrospective cohort study was conducted at a tertiary university hospital including post-bariatric women who underwent mastopexy between January 2016 and May 2024. Patients were divided into two groups: autologous mastopexy (n=74) and implant-based mastopexy (n=64). All procedures were performed by a single surgeon using standardized protocols. Primary outcomes were postoperative complications within 6 months. Secondary outcomes included reoperation rates and patient satisfaction assessed using a numeric scale (0–10). Multivariate logistic regression adjusted for age, preoperative BMI, and total weight loss.

A total of 138 patients were analyzed. Implant-based mastopexy showed a significantly higher overall complication rate compared with autologous mastopexy (46.9% vs 27.0%, p=0.016) and a higher reoperation rate (34.4% vs 13.5%, p=0.004). Recurrent ptosis occurred more frequently in the implant group (15.6% vs 1.4%, p=0.003), whereas wound dehiscence or necrosis was more common after autologous procedures (6.8% vs 0.0%, p=0.015). Implant-related complications, including displacement and capsular contracture, were observed in 12.5% of implant cases. Patient satisfaction was comparable between groups (7.6 ± 2.1 vs 7.4 ± 2.4, p=0.684). Subgroup analysis suggested elevated complication rates even with moderate implant volumes.

In post-bariatric patients, implant-based mastopexy is associated with higher complication and reoperation rates compared with autologous techniques, while patient satisfaction remains similar. Autologous mastopexy should be considered the first-line approach when feasible, reserving implants for carefully selected patients requiring volume restoration.

Background Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide and tirzepatide, are increasingly used for obesity and diabetes, contributing to a growing population undergoing reduction mammaplasty after medically induced weight loss.1,2 Incidental proliferative, atypical, or malignant lesions in reduction specimens are uncommon (0–4.6%) and largely associated with baseline risk factors and age, particularly in women over 40 years.3,4 Current literature shows no clear association between GLP-1 use and breast neoplasia, and data specific to reduction specimens are limited. While GLP-1 agonists may have protective, weight-independent anticancer effects, their impact on baseline breast pathology remains unknown. This study evaluates whether GLP-1 use is associated with a distinct spectrum of incidental breast pathology.

Methods A retrospective cohort study of 342 adults undergoing bilateral reduction mammaplasty (January 2023–February 2024) was performed. Patients were stratified by GLP-1 use, including active use at surgery. Variables included breast cancer risk factors, preoperative imaging, GLP-1 exposure, bariatric history, and weight-loss characteristics. Pathology findings were categorized as benign/nonproliferative, proliferative without atypia, atypical/high-risk, or malignant. The primary outcome was any proliferative or higher-risk lesion; secondary outcomes included atypical/high-risk lesions and malignancy. Outcomes were compared between GLP-1 users and non-users.

Results Of 342 patients, 42 (12.3%) were active GLP-1 users and 300 (87.7%) were non-users. GLP-1 users had higher BMI (39.6 vs 32.4 kg/m², p<0.001), higher rates of diabetes (28.6% vs 5.0%, p<0.001), and more abnormal preoperative imaging (19.0% vs 6.0%, p=0.003). Median GLP-1 duration before surgery was 76 days, with median weight loss of 18.1 kg (17.0%). Overall, 86.8% had benign pathology, 9.4% proliferative lesions without atypia, and 3.8% atypical/high-risk/malignant findings. Rates of any proliferative or higher-risk lesion (16.7% vs 12.7%, p=1.000) and atypical/high-risk/malignant lesions (7.1% vs 3.3%, p=0.205) were similar between groups. Resection weights were greater in GLP-1 users (906 vs 743 g, p=0.010).

Conclusions GLP-1 users undergoing reduction mammaplasty demonstrated distinct baseline characteristics, including higher BMI, diabetes prevalence, and abnormal preoperative imaging; however, GLP-1 use was not associated with a significant difference in incidental proliferative or higher-risk breast pathology. These findings suggest GLP-1 use does not meaningfully alter the baseline pathology profile of reduction specimens and support continued use of standard screening and histopathologic evaluation practices.

References 1. Nahabedian MY, Deva AK, Ahmed D, Fanzio P, Hammer J. GLP-1 receptor agonist–associated weight loss and aesthetic breast surgery: a narrative review and experience-based recommendations for plastic and reconstructive surgeons. Aesthet Surg J Open Forum. 2026;ojag054. doi:10.1093/asjof/ojag054 2. Friedman O, Tal D. Breast reduction outcomes in massive weight loss: a comparative analysis of GLP-1 receptor agonist users, post-bariatric surgery patients, and controls. J Plast Reconstr Aesthet Surg. 2025;110:219-228. doi:10.1016/j.bjps.2025.09.023 3. Usón Junior PLS, Callegaro Filho D, Bugano DDG, et al. Incidental findings in reduction mammoplasty specimens in patients with no prior history of breast cancer: an analysis of 783 specimens. Pathol Oncol Res. 2018;24:95-99. doi:10.1007/s12253-017-0230-6 4. Üstün GG, Çırak A, Yüceer ÖS, Dağ O, Kösemehmetoğlu K, Uzun H. Long-term outcomes and oncologic implications of histopathological findings in breast reduction specimens: a 15-year follow-up study. Aesthet Surg J. 2026;46(3):329-335. doi:10.1093/asj/sjaf263

Background Collateralization and angiogenesis of lymphatic channels are thought to develop as alternative outflow pathways in response to lymphatic obstruction following trauma. In the chest, these aberrant lymphatic pathways can be visualized draining to contralateral lymph node basins using indocyanine green (ICG) lymphography. In our prior work, we demonstrated that radiation significantly obliterate regional lymphatics, while other cancer treatments also impair lymphatic flow to varying degrees. In this study, we aimed to assess the relationship between cancer treatments and the formation of new lymphatic pathways via collateralization and angiogenesis.

Methods We performed a retrospective review of breast cancer patients who underwent ICG lymphography of the chest between December 2014 and January 2026. First, we compared the prevalence of cross-body drainage pathways between healthy individuals and breast cancer patients. We then used multivariate analysis to evaluate the association between cancer treatments, type of mastectomy and reconstruction with the development of cross-body lymphatic drainage.

Results Our cohort included 95 breast cancer patients (173 hemi-trunks) and a control subgroup of 20 women (40 hemi-trunks) without a history of breast cancer or prior interventions. Among our control group, no cross-body drainage was observed. This was significantly different from the breast cancer group, in which 45% (n = 55) of hemi-trunks demonstrated contralateral drainage (P < 0.05). Overall, 78.6% of patients underwent mastectomy, 26.6% axillary dissection, 65.3% chemotherapy, and 42% radiation therapy. On multivariate analysis, radiation therapy was significantly associated with an increased incidence of contralateral drainage. Additionally, individuals with inguinal drainage pathways were more likely to exhibit cross-body lymphatic flow (18%).

Conclusion Cross-body lymphatic drainage is significantly less common in individuals without prior cancer treatment. These contralateral pathways are more likely to develop in patients who have undergone radiation therapy and may serve as alternative outflow tracts in truncal lymphedema. Similarly, inguinal lymphatic pathways may contribute to compensatory drainage of the trunk following cancer treatment.

Introduction: The decision to undergo breast reconstruction should ideally be influenced by both patient and disease factors. There is concern that some patients may only be offered reconstruction based on coverage by their insurance, reimbursement methods, external factors related to the opinion of their provider, or the facility in which they receive treatment. This study assessed how insurance status and facility type influence autologous breast reconstruction.

Methods: Using the National Cancer Database (NCDB), we analyzed women ≥18yo, with T1-T3 Invasive Ductal Carcinoma. Race/Ethnicity, Tumor Grade, and Tumor Biology were controlled for in this analysis. Multinominal logistic regression was used to assess influential factors on reconstruction type, with this analysis focused specifically on abdominal autologous tissue reconstruction.

Results: Using the 2022 NCDB, 374 out of 56,626 patients were identified who underwent reconstruction using an abdominal tissue flap. 286 (76%) had private insurance compared to 3 (0.8%) of those without insurance (p=0.066; q=0.11; OR 3.05 [95 % CI 0.93-10.0]). Medicaid or Medicare insurance did not offer any significantly different odds of undergoing autologous abdominal tissue flap reconstruction compared to those without insurance. Medicaid: (19 (5%), p=0.9; q>0.9; OR 0.90 [95 % CI 0.24-3.29]) and Medicare: (56 (15%), p>0.9; q>0.9; OR 0.94 [95 % CI 0.37-3.23]). Similar trends were identified with autologous flap reconstruction using tissue from sites other than the abdomen. 146 (39%) of patients undergoing abdominal tissue flap reconstruction received their care at an Academic/Research Institution compared to 15 (4%) of patients at a community hospital (p=0.012; q=0.023; OR 2.08 [95 % CI 1.18-3.69]). 155 (41%) of patients had their care at a Comprehensive Community Cancer Program compared to 15 (4%) of patients at a community hospital (p=0.048; q=0.084; OR 1.78 [95 % CI 1.01-3.14]).

Conclusion: The 2022 NCDB demonstrates that patients were more likely to undergo autologous abdominal flap reconstruction if they had private insurance or when cared for at academic institutions or comprehensive cancer centers. The exact reason why autologous flap reconstruction was more inaccessible to those who were uninsured or with government-issued insurance is not clear from this database and is subject to the inaccuracies and completeness of the administrative data. However, concerns regarding reimbursement bias are a possible explanation and suggest a significant disparity. This is both a legal and ethical conundrum that will require the coordinated effort among academic and private providers to find solutions.

Purpose: The impact of mastectomy incision design on patient-reported outcomes following immediate breast reconstruction remains unclear, with no clear superior or preferred choice of incision type. The aim of this study is to compare surgical and patient-reported outcomes amongst breast cancer patients undergoing mastectomy and immediate breast reconstruction with four different incision designs. Methods: A retrospective cohort study was performed of 187 patients undergoing mastectomy with immediate breast reconstruction. BREAST-Q patient-reported outcome measure was utilized to assess satisfaction and quality of life in breast surgery patients. Incision types included inframammary fold (IMF, n=62), Wise pattern (n=17), periareolar vertical incision (n=77), and periareolar transverse incision (n=29). BREAST-Q scores were collected preoperatively and at 3 and 12 months postoperatively. Outcomes were compared across incision groups using one-way ANOVA with post-hoc testing. Complication rates were compared using chi-square analysis. Results: Baseline BREAST-Q scores were comparable across incision groups. At 12 months, significant differences were observed in satisfaction with breasts (p=0.024), satisfaction with outcome (p=0.024), psychosocial well-being (p<0.001), sexual well-being (p<0.001), and satisfaction with information (p=0.009). Patients who underwent immediate breast reconstruction with periareolar transverse incisions demonstrated the highest scores across all domains (mean = 74.75), whereas patients undergoing Wise pattern incisions were associated with the lowest scores, including markedly reduced sexual well-being (mean = 28.63) and psychosocial well-being (mean = 53.44). Post-hoc analysis confirmed significantly inferior outcomes in the Wise cohort compared to other incision types. There was no significant difference in complication rates between incision groups (p=0.537). Conclusion: Mastectomy incision type significantly impacts long-term patient-reported outcomes following immediate breast reconstruction. Periareolar transverse incisions are associated with superior satisfaction and quality-of-life outcomes, while Wise pattern incisions are associated with less-favourable patient-reported outcomes, without increased complication risk.