Mallory A. Rowley

Professional health care organizations including the American Society of Plastic Surgeons (ASPS) historically provide guidance to medical providers in the wake of major medical news and events. Consider, for example, the ASPS guidance published in response to the December 17, 2020 Food and Drug Administration (FDA) briefing document of the Vaccines and Related Biological Products Advisory Committee for the Moderna COVID-19 (coronavirus disease 2019) Vaccine.[1] This information provides a framework for physicians to guide patient-physician conversations in formalized health care settings. However, it provides little insight into tangible patient concerns during the contemplation stage of decision-making prior to formalized patient consultations. We suggest utilizing Google Trends (GT) as a real-time tool to aid in identifying patient concerns. There have been several previously published case reports commenting on the immunogenicity of hyaluronic fillers as well as COVID-19 vaccine hypersensitivity and dermal manifestations.[2] [3] [4] [5] In theory, statements from professional organizations have a broader audience base than research articles from independent bodies including research institutions and universities. Few tools are available to both analyze how the public perception changes and capture significant concerns in the wake of these statements. In this virtual era where health-related information is readily accessible to patients via Internet searches, patients often form biases and premature decisions regarding treatment options prior to ever setting foot—or meeting virtually—in a provider's office.[6] [7] Additionally, there is an ever-growing body of literature supporting the use of social media and its utility in communicating with patients, particularly within the field of plastic and reconstructive surgery.[8] [9] [10] In order for physicians to address patient concerns on their Web-based platforms in the absence of in-person patient consultations, we advocate for the use of free analytical tools, particularly GT, to predict and mitigate patient concerns. We used a GT analysis to examine whether public interest in and concern over dermal fillers and related injectable products, namely botulinum toxin, increased in the wake of FDA adverse event reports, specifically the aforementioned December 2020 FDA Briefing. In our analysis, the following search terms ([Table 1]) were queried on GT (Google LLC., Mountain View, CA). These search terms were grouped by the following categories: general terms, adverse reaction terms, safety consideration terms, procedural terminology, brand names of botulinum toxin, and brand names of dermal fillers. These search terms were chosen to capture the various aspects of patient concerns regarding these products, their uses, and safety with respect to the COVID-19 vaccine. The search terms were gathered from November 1, 2019 to November 1, 2021. These dates provided a year's worth of data before and after the inflection point—November 1, 2020—which was chosen to capture the media coverage leading up to the official FDA statement released in December 2020. GT normalizes the volume of the search terms to compare them against one another. Thus, the data extracted is assigned a value from 0 to 100 to represent the relative search volume for each term. Once the data had been extracted from the GT platform for each search term, a bivariate regression analysis of panel data was utilized to explore whether or not the search term volumes were significantly increased after the chosen inflection point of November 1, 2020, as compared with the search volume prior to the inflection point. The data inputs were grouped by search volume for each term up to the inflection point of November 1, 2020, and search volumes for each term following the inflection point. Significant increases or decreases were statistically determined with a p-value of < 0.05 at a 95% confidence interval. [Table 2] demonstrates that general terms (p < 0.001), safety consideration terms (p = 0.034), procedural terminology (p < 0.001), brand names for botulinum toxin (p < 0.001), and brand names for dermal fillers (p = 0.049) had significantly different relative search volume before versus after the chosen inflection point of November 1, 2020. Our GT analysis demonstrated a significant increase in search terms, and therefore public interest, related to injectable products, the COVID-19 vaccine, and their adverse effects following the December 2020 FDA Briefing. GT analysis allows providers to accurately query public interest in, and concern over, medical procedures in the absence of face-to-face, individual patient meetings. Using free, publicly available analytical tools allows physicians the ability to tailor patient education on social media or other Web-based platforms to anticipate and mitigate patient concerns. M.A.R. and K.T. were involved in conception, writing, and editing. J.K.S. was involved in data collection, analysis, and writing. R.N. was involved in conception and editing. Received: 27 January 2022 Accepted: 30 June 2022 Article published online: 28 March 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Instagram (Menlo Park, CA) has become a popular means of advertisement for aesthetic surgery procedures, influencing patients’ likelihood of undergoing a procedure. This study aims to explore public interest in aesthetic procedures before and after the Instagram platform began to obtain popularity via Google Trends (Google, Mountain View, CA), a platform with previously demonstrated utility for tracking interest in surgical procedures. We hypothesize that as a result of increased medical marketing on Instagram, there is an increase in public interest in plastic surgery elective procedures. Trends in the United States for given search terms and volumes were gathered via Google Trends between April 2004 to January 2022. Search terms included popular aesthetic procedures based on the 2020 Aesthetic Plastic Surgery National Data Bank Statistics. The search volumes were normalized, and a bivariate regression analysis of panel data was then applied to the aggregate trendlines to determine if a statistically significant change in search volume occurred following the increase in user traffic of the Instagram platform. We found significant variations in search volume for plastic surgery procedures before and after April 2012. Blepharoplasty, Botox, brachioplasty, breast implant removal, breast reduction, brow lift, butt lift, hair transplantation, lip augmentation, male breast surgery, mastopexy, mentoplasty, otoplasty, platysmaplasty, rhinoplasty, and thighplasty (pp = 0.003) had a statistically significant decrease in search volume after April 2012. We observed a significant increase in public interest in both surgical and non-surgical aesthetic procedures after Instagram gained popularity in April of 2012.

Patients routinely use social media to locate providers, review before-and-after photographs, and discuss experiences, making it a powerful marketing tool for plastic surgeons. Few studies have systematically evaluated plastic surgery app content. Our study aims to analyze engagement levels and content posted by top plastic surgeon influencers on Instagram (Menlo Park, CA). We conducted a cross-sectional study to identify the top ten global plastic surgeons on Instagram in February 2022. Influencers were ranked based on number of followers and their latest 20 posts were analyzed. A total of 200 posts were categorized by two independent trainees as one of the following: marketing, education, personal, and miscellaneous. The number of likes was recorded as a proxy for engagement and average engagement for each category was calculated. The top ten influencers work primarily in private practice focusing on aesthetic procedures. Out of 200 categorized posts on Instagram, marketing posts had the greatest presence (64.5%), followed by personal (20%), miscellaneous (11%), and educational (4.5%). More still images were posted (56.5%) than videos (43.5%). Highest average engagement was for personal content (p = 0.005). No significant differences in engagement levels were found between photo and video content (p = 0.24). While most content posted relates to marketing efforts, many influencers are also using social media to post about their personal lives and promote their ancillary businesses. Although marketing content was most common, engagement levels were highest for personal and educational content, and no significant differences in engagement were found between videos and photos.

The surgical literature debates about whether an average intraoperative fractional inspired level of oxygen (FiO₂) greater than 80% confers lower postsurgical complication rates. Although some evidence demonstrates minimal or no difference in short-term mortality or surgical site infections, few studies suggest negative long-term outcomes. To the best of our knowledge, this is the first study examining the relationship between intraoperative FiO₂ levels and postoperative outcomes in the setting of immediate prepectoral implant-based breast reconstruction. The authors retrospectively reviewed the complication profiles of 309 patients who underwent prepectoral 2-stage breast reconstruction following mastectomy between 2018 and 2021 at a single institution. Two cohorts were created based on whether intraoperative FiO₂ was greater than 80% or less than or equal to 80%. Complication rates between the cohorts were analyzed using Chi-squared test, Fisher’s exact test, and multivariable logistic regressions. Variables examined included demographic information; smoking history; preexisting comorbidities; history of chemotherapy, radiation, or axillary lymph node dissection; and perioperative information. Chi-squared and multivariable regression analysis demonstrated no significant difference between cohorts in complication rates other than reoperation. Reoperation rates were significantly increased in the FiO₂ greater than 80% cohort (P = 0.018). Multivariable logistic regression also demonstrated that the use of acellular dermal matrix was significantly associated with increased postoperative complications (odds ratio 11.985; P = 0.034). Complication rates did not statistically differ in patients with varying intraoperative FiO₂ levels outside of reoperation rates. In the setting of implant-based prepectoral breast reconstruction, hyperoxygenation likely does not lead to improved postsurgical outcomes.

Introduction Chest wall irradiation significantly decreases the strength and quality of breast tissue supporting prostheses, increasing the risk of skin breakdown and implant or tissue expander extrusion. Autologous tissue, including the latissimus dorsi (LD) or abdominal-based flaps, including the muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps, may be used to salvage reconstructions. However, data comparing outcomes of the two flap options remains limited. We compare postoperative outcomes from both flap types after autologous salvage reconstruction in irradiated breasts. Methods Charts were retrospectively reviewed from patients who underwent either chest wall radiation or postmastectomy radiation therapy followed by salvage autologous reconstruction with either a LD and an implant or an abdominal-based flap (muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps). Patients with a history of tissue expander or implant failure requiring autologous salvage as part of 2-staged or delayed-immediate breast reconstruction that were operated on between January 2005 and November 2015 were included. Basic demographics, comorbidities, and recipient site complications (infection, wound dehiscence, seroma, hematoma, fat necrosis, and flap failure) were collected. Results A total of 72 patients met the inclusion criteria which included 72 flaps; 35 LD and 37 abdominally based flaps. Demographics and comorbidities did not vary significantly between patient groups. Mean follow-up was 767.6 weeks, and all reconstructions were unilateral. Nineteen (26.4%) patients had at least one complication, most commonly minor infections (9.7%). Overall complication rates were not significantly different between flap groups (P = 0.083). Wound dehiscence was significantly higher in the abdominal group (P = 0.045), and fat necrosis also trended higher in this group (P = 0.085). Major infection trended higher in the latissimus group (P = 0.069). Conclusions When comparing outcomes of salvage flap-based reconstruction in radiated breast tissue, overall complication rates were similar when comparing postoperative outcomes between the LD- and abdominal-based flaps. Wound dehiscence was significantly higher when salvage reconstruction used an abdominal flap. Understanding the complications after salvage procedures can help inform decision making and optimize patient care to improve outcomes after breast reconstruction in the radiated breast.