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    Direct-to-implant retropectoral dual plane approach with autologous inferior-based dermal flap: does spy-elite laser angiographic system reduce complication rates?
    (2024) Eroğlu, Sinem; Büyükdoğan, Hasan; Duran, Alpay
    Purpose: The study aims to investigate the complications and long-term outcomes associated with retropectoral DTI breast reconstruction with IDF utilizing the SPY-Elite laser angiographic system. Material and method: This retrospective study was conducted from June 2017 to January 2023. We examined 52 patients (85 breasts) treated with a direct-to-implant retropectoral dual plane approach with IDF implant coverage. Informed consent was duly obtained from every participant. Inclusion criteria dictated that patients should have medium to large breasts and a second or third degree of ptosis, as per the Regnault ptosis scale. During the intraoperative evaluation, the mastectomy flaps and IDF were assessed with the SPY-Elite laser angiographic system using near-infrared imaging. We recorded patient demographics, characteristic data, and complications. Results: A total of 52 patients, aged 27 to 63, underwent 85 mastectomies using a direct-to-implant retropectoral approach with inferior dermal flap. The average age of the patients was 48, and their average body mass index was 30.8, with a range of 28 to 43. The distance from the nipple to the inframammary fold varied between 14 and 24 cm. The implants used had an average size of 275 cc, ranging from 250 to 650 cc. Textured anatomic implants with either moderate plus or high profile were used in all cases. The sternal notch to nipple distance for these patients ranged from 24 to 38 cm. During the evaluation using the SPY-Elite laser angiographic system, insufficient distal marginal perfusion was detected in five out of 85 inferior dermal flaps, measuring between 2 and 5 cm2. These areas were subsequently debrided, and the reconstructions were successfully completed, representing 5.8% of cases. No instances of necrosis related to IDF have been observed. There have been no failed assessments conducted by SPY ICG. In total, the complication rate was 15.2%, with minor complications occurring in 8.2% of the breasts (7 out of 85) and major ones in 7% (6 out of 85). The subjects were monitored for an average of 14 months, the duration ranging from 12 to 24 months. Conclusion: Inferior dermal flaps have considerable advantages, such as a natural autologous blood supply, a more realistic tissue thickness and texture, lower costs, and better tolerance to post-reconstruction radiation. Moreover, using the IDF technique and assessing the perfusion of IDF and mastectomy flaps through the SPY-Elite laser angiographic system appears to be a dependable, efficient way to achieve good cosmetic results in one operation, eliminating the need for additional surgeries. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.
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    Human vs machine: The future of decision-making in plastic and reconstructive surgery
    (2025) Duran, Alpay; Demiröz, Anıl; Çörtük, Oğuz; Ok, Bora; Özten, Mustafa; Eroğlu, Sinem
    Background: Artificial intelligence (AI)-driven technologies offer transformative potential in plastic surgery, spanning pre-operative planning, surgical procedures, and post-operative care, with the promise of improved patient outcomes. Objectives: To compare the web-based ChatGPT-4o (omni; OpenAI, San Francisco, CA) and Gemini Advanced (Alphabet Inc., Mountain View, CA), focusing on their data upload feature and examining outcomes before and after exposure to CME articles, particularly regarding their efficacy relative to human participants. Methods: Participants and LLMs completed 22 multiple-choice questions to assess baseline knowledge of CME topics. Initially, both LLMs and participants answered without article access. In incognito mode, the LLMs repeated the tests over 6 days. After accessing the articles, responses from both LLMs and participants were extracted and analyzed. Results: There was a significant increase in mean scores after the article was read in the resident group, indicating a significant rise. In the LLM groups, the ChatGPT-4.o (omni) group showed no significant difference between pre- and post-article scores, but the Gemini Advanced group demonstrated a significant increase. It can be stated that the ChatGPT-4.o and Gemini Advanced groups have higher accuracy means compared to the resident group in both pre and post-article periods. Conclusions: The analysis between human participants and LLMs indicates promising implications for the incorporation of LLMs in medical education. As these models increase in sophistication, they offer the potential to serve as supplementary tools within traditional learning environments. This could aid in bridging the gap between theoretical knowledge and practical implementation.
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    Round autoprosthesis: use of adipodermaglandular flap in T scar mastopexy
    (2024) Duran, Alpay; Çörtük, Oğuz; Eroğlu, Sinem
    Purpose: This study focuses on the use of round or anatomically shaped breast autoprosthesis with different volumes prepared from the central and lower poles of the breast. The technical details and surgical outcomes for patients with varying degrees of breast ptosis are discussed. Material and method: This study involved 42 patients who underwent the Wise-pattern superior pedicle mastopexy procedure using the adipodermaglandular island flap technique. The research spanned from December 2017 to August 2022. The study participants had not previously undergone breast surgery, did not desire breast implants, and exhibited grade 2 and 3 breast ptosis according to the Regnault Classification. Age and preoperative breast measurements of the patients were recorded for subsequent analysis. Measurements, such as the distance from the nipple-areolar complex to the inframammary fold and the distance from the suprasternal notch to the nipple-areolar complex, were taken both before the surgery and one year after. A systematic process was followed to identify acute and subacute complications during the postoperative follow-up period. Results: This study involved 42 patients with a mean age of 33.9 years (range: 23-49 years). These procedures were conducted between December 2017 and August 2022. The average SN-N distance before surgery measured 26.7 cm (range: 24-33 cm). One year after surgery, the average SN-N distance was 23.1 cm (range: 21.3-24.8 cm). The follow-up duration for the examined cases ranged from 12 to 18 months on average. Among the observed cases, delayed wound healing was noted in one instance, venous insufficiency of the nipple in another, and fat necrosis in a third case. The overall complication rate in the group was determined to be 7.1%. Conclusion: In our study, the detachment of dermal connections at the level of the inframammary fold (IMF) and the smooth advancement of the flap in the form of an "island flap" made a contribution to upper pole fullness. Furthermore, we hypothesize that the fusion of the medial and lateral ends of the flap will enhance tissue integration during the healing process, promoting compatibility between the autoprosthesis tissue and breast tissue. Regarding the rates of complications described, classic mastopexy techniques have exhibited similar rates in our findings.