Plastic and Reconstructive Surgery Highlights: Plastic Surgery Focus

The year 2025 brought forth many high-quality articles in the Plastic Surgery Focus section. This section, previously known as Special Topics, addresses a wide array of issues important to plastic surgeons that are not covered in other sections, such as those related to business, education, global health, technology, and wellness. In 2025, many important subjects were covered, ranging from fundamental areas, such as research methodology and venous thromboembolism prevention, to emerging trends, such as private equity, antiobesity medications, and artificial intelligence. It is my pleasure to highlight 10 of these articles, which were chosen based on their relevance, innovativeness, and quality. For each article, a summary is provided, as well as a discussion of its impact and relevance. It was exceedingly difficult to select only a subset of articles from 2025, as they were all truly excellent. Accordingly, I strongly encourage readers to examine the full set of works within the Plastic Surgery Focus section. SELECTED ARTICLES “Medical Weight Management Considerations in Plastic Surgery”1 Obesity continues to be a major public health concern, and its impact on and relevance to plastic surgery are well known. In recent years, there has been a significant rise in the use of antiobesity medications, such as glucagon-like peptide-1 agonists. In their article, Paranzino et al. provide a comprehensive review of medical weight management considerations in plastic surgery, including pharmacologic obesity therapy and a comparison with surgical weight loss.1 The authors also discuss implications for plastic surgeons, including perioperative management of patients who take glucagon-like peptide-1 agonists. This article is a timely and practical review for plastic surgeons who perform body contouring as well as those who care for patients who may take antiobesity medications. “P Value Reporting and Reliability in Plastic and Reconstructive Surgery: A Primer for Readers and Investigators”2 The P value is fundamental to statistics, and a thorough understanding of it is essential to interpretating research. Fahmy et al. provide a thorough review of the P value for readers who are new to research as well as those are already well-versed in statistics but may seek a refresher.2 The authors summarize the foundations and meaning of the P value as well as important considerations, such as study design, confidence intervals, and pitfalls for interpretation. Of note, the authors use numerous examples of research to demonstrate how to apply these concepts appropriately. Given the ubiquity of the P value in research, this article is highly recommended as a reference for readers and investigators. “Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity”3 Advanced practice providers (APPs) play an essential role in both nonsurgical and surgical fields to support the work of physicians as well as provide autonomous care to patients. In this research article, Layon et al. present a 10-year experience of the impact of APPs in one of the largest pediatric surgery departments in the United States. Such a longitudinal study serves as an important addition to existing smaller-scale studies on this subject.3 The authors examined clinical volume, financial outcomes, and productivity data. With the increasing role of APPs, they observed a concurrent increase in the surgical conversion rate for physicians, work relative value units, and gross charges. Importantly, the authors describe their institutional experience with APPs, including how the volume and scope of practice increased over time and the reasons why, which serves as useful information for plastic surgeons who may be seeking to increase APP presence in their own practices. Layon et al. also discuss how making full use of the skillset of APPs (eg, independent clinics, first-assist in the operating room, performing independent procedures) contributed to the significant clinical growth they experienced. This article is highly recommended, as it provides valuable insights into how surgical practices can fully leverage APPs to optimize patient care and productivity. “Noninferiority Study Design: Application to Clinical Trials”4 In contrast to the P value, noninferiority study design may be less familiar to readers. A noninferiority study is a type of randomized controlled trial (RCT) that specifically aims to show that a new treatment is not unacceptably worse than the standard in exchange for additional nonefficacy benefits, such as reduced side effects or lower costs.4 As such, given the essential role of RCTs in evidence-based medicine, such studies are important for plastic surgeons to understand and use when appropriate. Wong et al. present the fundamentals of noninferiority study design. They used an example of medical students performing skin closure in comparison with the attending surgeon to illustrate how nonefficacy benefits may be incorporated into study design and how to interpret data for noninferiority, including in relation to factors such as confidence intervals. The authors also discuss practical applications of inferiority study design to plastic surgery. This article is recommended reading for all plastic surgeons as our field continues to aim for higher quality and higher levels of evidence in research. “Time and Cost Savings of Virtual Established Plastic Surgery Care Using Time-Driven Activity-Based Costing: Lessons from an Academic Clinic”5 Virtual clinic visits were essential during the COVID-19 pandemic, and in many institutions, telemedicine was continued because of benefits such as increased convenience and flexibility for patients. Tang et al. analyzed additional perceived advantages of virtual clinic visits: time and cost.5 They did so by studying physicians and physician assistants in the setting of an academic clinic. They found that the face-to-face time with the provider was similar between in-person and virtual clinic visits, but that there was overall time savings with virtual clinic visits related to the time spent during in-person visits on nonprovider activities (eg, rooming and waiting). This translated to reduced costs associated with virtual clinic visits. As productivity and access continue to be a priority for providers and hospitals, this study is significant in demonstrating the time and cost benefits of telemedicine. “Evaluating the Accuracy of Relative Value Unit and Operative Time Changes in Breast Reconstruction”6 Work relative value units (wRVUs) remain a key metric for productivity targets and bonuses for providers at many hospitals, making it essential that wRVUs are as accurate as possible. In their study, Rochlin et al. investigated wRVU changes implemented in 2021 by the Centers for Medicare & Medicaid Services for several breast reconstruction Current Procedural Terminology codes.6 The Relative Value Scale Update Committee made recommendations for wRVU changes for these codes based on newly surveyed operative times, while the Centers for Medicare & Medicaid Services used historical operative times. The authors used operative time data from the National Surgical Quality Improvement Program database to compare the Relative Value Scale Update Committee recommendations with the wRVU changes that the Centers for Medicare & Medicaid Services ultimately implemented. They found that the committee’s recommendations corresponded more closely with National Surgical Quality Improvement Program benchmarks, bringing into question the necessity and favorability of future efforts to re-evaluate other Current Procedural Terminology codes. This study provides much-needed evidence to support a more accurate process for evaluating wRVUs. “A Critical Analysis of Randomized Controlled Trial Quality in Plastic and Reconstructive Surgery”7 Although RCTs can be challenging to conduct in the field of plastic surgery, they remain a critical component of evidence-based medicine. Prior investigations have found that plastic surgery RCTs had significant deficiencies in reporting and methodology. With an increase in the number of RCTs in plastic surgery, Wong et al. performed a timely follow-up examination of the quality of these studies over a 10-year period.7 The authors reviewed 146 RCTs and found that the overall methodologic quality of these studies was moderate. They identify areas for improvement, including randomization, blinding, and sample size. This article is a useful guide for investigators designing, conducting, or reviewing RCTs as plastic surgeons continue to enhance the quality of research. “Artificial Intelligence Risk Prediction Tools for Alloplastic Breast Reconstruction”8 Artificial intelligence represents arguably the most significant technological advancement in recent times. The ability of artificial intelligence to perform tasks that require human-like intelligence, such as perception, decision-making, and learning from data, makes it of clear interest to health care providers. In their study, Chen et al. developed and evaluated traditional statistical and machine learning approaches to predicting complications in alloplastic breast reconstruction in 6513 immediate tissue expander breast reconstructions over a 7-year period.8 Using these data, the authors found that incorporating both traditional statistics and machine learning analyses was necessary to create the most accurate risk prediction tools. This is both a clinically as well as technologically relevant study on the use of artificial intelligence in plastic surgery, and we are likely to see many further investigations such as this one in the future. “Private Equity Investment in Plastic Surgery Clinics: A Scoping Review”9 In recent years, private equity has had an expanding role in the field of plastic surgery. Many readers are likely to know plastic surgeons whose practices have had investment by private equity firms. As a relatively recent trend, there is still much to be determined in terms of the impact of these investments and considerations for plastic surgeons. Roth et al. present a literature review of 8 studies on this subject.9 They found that private equity investments can provide some advantages to plastic surgery practices, particularly financial and operational ones, but may compromise the quality of patient care and physician autonomy. This article identifies preliminary but important themes regarding private equity investments and serves as a needed foundation for more standardized and longitudinal investigations into this subject. “Venous Thromboembolism Chemoprophylaxis in Plastic Surgery: A Randomized Controlled Trial of Apixaban versus Enoxaparin”10 The prevention of venous thromboembolism (VTE) continues to be an important topic for plastic surgeons. As there have been many previous studies on this subject, current research requires the highest levels of evidence. Momeni et al. provide such as study: a blinded RCT comparing enoxaparin with apixaban for VTE chemoprophylaxis in patients undergoing microsurgical abdominally based breast reconstruction.10 As an oral agent that does not require monitoring or weight-based dosing, apixiban offers several potential advantages over enoxaparin. In 79 patients, the authors found no occurrences of VTE in either group, and apixiban demonstrated a similar and low risk of bleeding compared with enoxaparin. On the basis of this work, apixiban is a promising alternative agent for VTE prevention that offers advantages over existing options, with similar efficacy. CONCLUSIONS Plastic surgery continues to evolve by remaining at the forefront of medical and technological advancements while adhering to the fundamentals of evidence-based research. The 10 studies highlighted in this article exemplify these aspects of our field and provide valuable insights and findings that will allow plastic surgeons to continue to advance and improve outcomes. DISCLOSURE The author has no financial disclosures or conflicts of interest to report.