In this week's edition
- ✍️ Letter from P'Fella
Navigating the Confidence Curve in Plastics! - 🤓 The Sunday Quiz
How well do you know Breast Recon? - 🖼️ Image of the Week
Abdominal DIEP flap harvesting: Step-by-step images. - 🚑 Technique Tip
Why does CT angio matter for DIEP flap recon? - 👁️ What's Trending?
Too much research to become a resident. - 📋 Featured Article of the Week
DIEP flap reconstruction: Surgical steps and complications. - 📖 What Does the Evidence Say
Impact of radiotherapy on breast reconstruction. - 🔥 Articles of the Week
First DIEP flap evidence, 100 step DIEP flap process, & prepectoral breast reconstruction: with 1 sentence summaries. - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
Ever think you’ve nailed something, only to realize later you were completely out of your depth? That’s the Dunning-Kruger Effect in action, and plastic surgery is full of it. From the “I can handle this flap” confidence boost as a junior to the quiet self-doubt of seasoned consultants who know just how complex things can get...
Here’s the deal: that early overconfidence is dangerous. It’s the “I know enough to be risky” phase where shortcuts seem fine, and complications feel like they happen to other surgeons. But the flip side? As experience grows, many of us become overly cautious, second-guessing our expertise when we’re the best-equipped person in the room.
This curve isn’t just a theory—it’s something we need to own. Whether you’re flying high or battling imposter syndrome, staying humble, asking for feedback, and knowing when to challenge yourself is where the real growth happens.
This phenomenon has been observed in various surgical specialties, including reconstructive microsurgery, general surgery, and cardiac surgery (Pafitanis et al., 2019; Porto et al., 2024; Heinemann, 2022)
So, where are you on this curve? Early confidence? Mid-level panic? Quiet mastery? Just reply to this email 😄
P'Fella ❤️
The Sunday Quiz
How Well Do You Know Breast Recon?
Welcome to the next round of The Weekly Quiz.
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.
Image of the Week
Abdominal DIEP Flap Harvesting
In this section, we feature an anatomical illustration. This week, we’re looking at an intraoperative photo documentation of abdominal DIEP flap harvesting.
Read more about DIEPs here
Technique Tip
Why Does CT Angio Matter for DIEP Flap Recon?
This week’s technique focuses on preoperative planning for DIEP flap reconstruction.
Preoperative CT angiography precisely identifies dominant perforators, ensuring efficient flap harvesting and improving surgical outcomes. Studies have shown that CTA reduces operative time, blood loss, and hospital stay (O'Connor et al., 2016). However, intraoperative changes are still necessary in 44% of cases due to CTA limitations (Keys et al., 2013).
What's Trending?
Too Much Research
This edition looks at the average research items required for residency. See the numbers below 👇
Featured Article of the Week
DIEP Flap Reconstruction
DIEP Flap Reconstruction
The DIEP flap is a gold standard for autologous breast reconstruction, offering superior vascularity and minimal donor-site morbidity.
Explore the anatomy, surgical steps, and complications of DIEP flap reconstruction 👇
What Does the Evidence Say?
Impact of Radiotherapy on Breast Reconstruction
Patient-reported outcomes, such as satisfaction with breasts and psychosocial well-being, are also negatively affected by radiotherapy (Devulapalli et al., 2018; Kronowitz, 2012). Autologous reconstruction appears to mitigate some of these adverse effects, showing lower complication rates and higher patient satisfaction compared to implant-based approaches in irradiated patients (Jagsi et al., 2018).
The timing of radiotherapy relative to reconstruction may influence outcomes, with radiation following reconstruction potentially increasing tumor recurrence and patient mortality (Nahabedian & Momen, 2008). Breast reconstruction requires thoughtful planning of type and timing relative to radiotherapy (Rozen & Ashton, 2012).
Articles of the Week
3 Interesting Articles with 1 Sentence Summaries
Inferior epigastric artery skin flaps without rectus abdominis muscle reduce herniation and bulk issues, relying on single perforator survival for effective reconstruction.
A process mapping approach reduced DIEP flap surgery time by 56.1 minutes without compromising outcomes, demonstrating streamlined efficiency and potential for concurrent procedures.
Prepectoral breast reconstruction shows comparable short-term complication rates to submuscular techniques but with increased upper pole rippling and implant palpability.
