Plastic Surgery

Neurotization meaningfully improves sensory recovery after breast reconstruction

This systematic review of 40 studies evaluated sensory outcomes after neurotized autologous and implant-based breast reconstruction using objective testing and BREAST-Q data. Across studies, neurotization consistently accelerated and enhanced return of tactile, thermal, and protective sensation versus non-neurotized controls, especially in DIEP and TRAM flaps. Direct nerve coaptation was most common, with allografts, conduits, and autologous grafts providing alternatives when tension-free repair was not possible. Implant-based reconstructions with nerve allografts also showed improved nipple–areola and skin sensation, often linked with higher satisfaction and quality of life. Evidence is largely small, retrospective series without randomization, so technique choice and cost–benefit still require individualized judgment. 1

XGBoost model predicts major complications after postmastectomy reconstruction

This prognostic study developed machine-learning models to predict 1-year major complications after implant-based or autologous postmastectomy breast reconstruction. Among 411 women (667 breasts), the major complication rate, defined as unplanned reoperation or rehospitalization, was 25.8%. An XGBoost model using structured and manually abstracted clinical data achieved an AUROC of 0.83 and outperformed a random forest model. Key predictors included smoking, adjuvant radiotherapy, body mass index, age, and diabetes, aligning with known clinical risk factors. These data support the feasibility of individualized complication-risk estimation to inform reconstruction choices and counseling, pending external validation and workflow integration. 2

Early CO2 laser for burn scars recruits regenerative fibroblasts

This single-cell RNA-seq study profiled hypertrophic burn scars before and after three sessions of ablative fractional CO2 laser. Clinically good responders had scars less than six years old, while poor responders had scars older than six years. Good responders showed enrichment of extracellular-matrix–organization genes and predominance of regenerative mesenchymal fibroblasts after treatment. Poor responders displayed inflammatory gene signatures, persistent EN1 expression, and upregulated TIMP1 transcription with inflammatory fibroblast predominance. TRPS1, a regeneration-associated gene, increased after treatment in good responders but decreased in poor responders, supporting earlier laser intervention for better remodeling. 3