A Comprehensive Evaluation of Primary Breast Augmentation Education Videos for Surgical Trainees

The PIP mammary prosthesis: A product recall study

Subfascial (SF) pocket breast augmentation (BA) has gained popularity, whereas the transaxillary approach (TAA) offers the benefit of an inconspicuous scar. Previous reports on both techniques involved limited follow-up/samples, and few clinical studies specifically address surgical technique and outcomes following primary and secondary BA. The purpose of this study was to assess outcomes from the SF TAA technique in a large series of patients who underwent primary and secondary BA. A retrospective cohort of patients who underwent BA between 1999 and 2024 was identified. The primary outcome was occurrence of incision and implant/pocket complications. Regression logistic analysis evaluated risk factors including age, body mass index, smoking, implant surface/volume, and fat grafting. The cohort contained 1015 patients (mean age, 28.5 ± 7.3 years), and the average follow-up was 77.6 ± 38.6 months. In primary BA, 212 patients (23.4%) experienced at least 1 complication, most frequently capsular contracture. More complications were seen in secondary BA ( P = 0.016). Multivariate regression identified body mass index less than 18.5 kg/m 2 as a significant risk factor for incision complications, whereas textured surface (OR, 2.70; P < 0.001) and implant volume greater than 350 cc (OR, 2.79; P < 0.001) were risk factors for implant/pocket complications. Despite extensive research on BA procedures, studies on SF TAA procedures are limited and have not analyzed long-term outcomes following primary/reoperative operations. These results demonstrate that SF TAA is a reliable technique, and the data are compatible with other studies using different BA approaches. Knowledge of the axillary and pectoralis fascia anatomy allows surgeons to safely implement the SF TAA technique and minimize risk. Therapeutic, III.

Background: Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB). Methods: All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated. Results: Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis. Conclusions: The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos.

For decades, implant-based breast augmentation has been one of the most performed surgical procedures for cosmetic purposes around the world. Hence, novel manufactured implants should be critically investigated to prove them safe and effective. Here, the authors describe the first independently conducted clinical study on Nagor Impleo textured round breast implants. For this retrospective study, outcomes of 340 consecutive female patients undergoing primary cosmetic breast augmentation were analyzed. Demographic and surgical data as well as outcomes and complications were evaluated. Furthermore, a survey concerning effectiveness and aesthetic satisfaction after breast augmentation was examined. All 680 implants were placed in a submuscular plane with incisions at the inframammary fold. The main indications for surgery were hypoplasia and hypoplasia with asymmetry. The mean implant volume was 390 cc and the main type of projection was high profile. The most common complications were hematoma and capsular contracture (0.9 percent, respectively). The overall revision rate for complications was 2.4%. Additionally, almost all patients showed increased quality of life and aesthetic satisfaction after a breast augmentation. Hence, all patients would undergo breast augmentation again with these newly launched devices. Nagor Impleo implants demonstrate a low complication rate and high safety profile. Although high aesthetic satisfaction and quality of life results were achieved, analysis of an even larger series over a longer period of time would be beneficial to evaluate the reliability of this implant.

This study aims to evaluate the informational quality of oral cancer-related videos on YouTube and Bilibili. A total of 300 oral videos that met the inclusion and exclusion criteria were selected for analysis. The selection comprised 150 videos from 111 uploaders on YouTube and 150 videos from 134 uploaders on Bilibili. YouTube videos received a greater number of views and likes, while there was no significant difference in average likes per 30 days or comments between the two platforms. The majority of YouTube uploaders were hospitals/non-profit organizations (66.7%) and for-profit companies (17.1%), while Bilibili uploaders were mainly self-media (55.2%) and doctors (29.1%). YouTube videos covered a broader range of topics compared to Bilibili videos. Though solo narration was the most prevalent video style across both platforms, YouTube exhibited a higher preference for TV shows/documentaries (31.3%). Video quality was assessed using the four tools: Though mDISCERN (modified DISCERN) and PEMAT-Actionability (Patient Education Materials Assessment Tool) were similar across platforms, YouTube videos scored higher on PEMAT-Understandability, VIQI (Video Information and Quality Index), and GQS (Global Quality Score) in comparison to Bilibili videos. Videos produced by health professionals were considered more reliable. Spearman correlation analysis revealed no strong relationships between video quality and audience interaction. In conclusion, YouTube videos exhibited higher audience engagement and video quality, yet improvements are needed on both platforms. In order to promote high-quality health information, it is essential to encourage the development of more professional content creators and to optimize platform algorithms.

Tumescent local anesthesia (TLA) consists of infiltration of saline solution with lidocaine and epinephrine into the tissues to obtain regional anesthesia and vasoconstriction. The use of TLA in augmentation mammoplasty has been described for sub-glandular positioning. We describe a modified TLA technique for primary sub-muscular breast augmentation reporting our experience during the past 7years. From 2010 to 2017, 300 patients underwent bilateral primary sub-muscular breast augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. Firstly, the solution was infiltrated between the pectoral fascia and the mammary gland, secondarily, during surgery, under the pectoralis major muscle. The average amount of tumescent solution infiltrated while performing TLA was 740mL per breast. No signs of adrenaline or lidocaine toxicity were reported and conversion to general anesthesia was never required. In all patients, no pain nor discomfort was reported during the pre-operating infiltration and surgical procedure. We reported a major complication rate of 3.3% (4 hematomas and 6 seromas) and a minor complication rate of 6.0% (8 implant dislocation and 10 dystrophic scars formation). TLA represents a safe and efficacious technique for performing breast augmentation surgery with sub-muscular implant positioning. This technique guarantees good pain control during and after surgery and has low incidence of postoperative side effects. Patients subjected to sub-muscular breast augmentation with TLA were satisfied. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objectives: In this study we evaluated 40, top recommended, laparoscopic appendectomy and laparoscopic cholecystectomy videos located on public domain websites using eight criteria created by a panel of third year medical students and general surgeons. We hypothesized that there is a lack of quality, thorough educational laparoscopic surgical videos appropriate for third year medical students to review in preparation for the Surgery rotation. Methods: Utilizing a panel, which included four third year medical students and two general surgeons, we created an ‘ideal medical student educational video checklist.’ This checklist included 8 vital criteria. We selected 40, top recommended, videos available on YouTube and Google Video search engines, using ‘laparoscopic cholecystectomy’ and ‘laparoscopic appendectomy’ as key terms. Each video was evaluated by four third year medical students individually, using a binary system ‘meets’ or ‘does not meet’ each criterion. Individual scores were averaged, producing a single score for each video. Results: 0/40 (0%) of the videos met all eight of the criteria. 26/40 (65%) of the videos did not meet half of the criteria. The top performing videos 7/40 (17%) only met 5/8 criteria. Conclusions: We identified a lack of quality and thorough educational surgical videos appropriate for third year medical students and a need for improved online video based instruction. Our checklist can be utilized as a guide for anyone creating surgical videos for medical student education in the future.

756 Background: The incidence of pancreatic cancer among young adults has sharply risen over the past decade. Young adults often utilize online educational media, such as YouTube videos, for information about their disease. These may be subject to a high degree of bias and misinformation; previous analyses have demonstrated low quality of other cancer-related YouTube videos. Thus, we sought to determine if patients can rely on YouTube videos for accurate information about pancreatic cancer, and we compared relevant YouTube videos with those published by NCI-designated cancer centers (CCs). Methods: We designed a novel search query and inclusion/exclusion criteria based on published studies evaluating YouTube user tendencies. These criteria were used to identify videos most likely watched by patients, which composed our “Patient-Focused” (PF) group. We compared PF videos with those uploaded by CCs by manually searching each CC’s affiliated YouTube and applying the same inclusion/exclusion criteria. Data were summarized by descriptive statistics. Videos were evaluated based on two well-known criteria, the DISCERN and JAMA tools, as well as a tool published by Sahin et al to analyze the contents of colorectal cancer videos. A score of ≥ 6 on the Sahin scale correlated with high quality information. We used t-test and Chi-squared test to analyze differences between groups. Results: 39 videos met inclusion criteria within the PF sample and 19 videos within the CC sample, total sample of 58 videos. The PF sample had mean Sahin scores of 4.24 ± 2.21, DISCERN scores of 2.15 ± 0.47, and JAMA scores of 1.77 ± 0.60. CC videos had mean Sahin scores of 3.84 ± 2.70, DISCERN scores of 2.25 ± 0.63, and JAMA scores of 2.00 ± 0.0. Perceived speakers’ ethnicity was 75% White (n=77), 21% Asian (n=21), and 4% Hispanic (n=4). There were no Black speakers. Most videos uploaded were fair or poor quality. 16.4% (n=27) were of average or high quality by the Sahin criteria, with 1 video receiving a perfect score. 9.6% (n=5) and 90.4% (n=47) were average or high quality by DISCERN and JAMA criteria, respectively. 8.6% (n=5) of videos discussed palliative care and 10.3% (n=6) discussed staging. Independent samples t-test revealed no significant differences between PF and CC videos for the Sahin criteria (p=0.429) and DISCERN criteria (p=0.387). The mean JAMA score was higher for CCs (2.0 ± 0.0) than the PF group (1.8 ± 0.6) (p=0.001). Chi-squared test revealed that CC and PF videos had similar speaker ethnic diversity (p=0.381). Conclusions: Educational pancreatic cancer YouTube videos demonstrate low to moderate quality information with limited speaker ethnic diversity. Given ongoing trends in the spread of misinformation through social media, CCs and other patient educators should be mindful of their role in producing high quality, comprehensive information for patients and their caregivers.

INTRODUCTION: YouTube is a popular video search engine among surgical trainees due to its wide availability and easy accessibility. However, the educational quality of YouTube surgical videos may vary due to lack of requirement for peer review. In contrast, PubMed provides millions of peer-reviewed videos, but not all PubMed content is freely accessible. The Laparoscopic Surgery Video Educational Guidelines Video Assessment Tool (LAP-VEGaS VAT) is a nine-item checklist for assessing the educational quality of laparoscopic surgical videos. Each item is scored from 0 to 2, with higher scores indicating higher educational quality. To our knowledge, LAP-VEGaS VAT has not been used to evaluate sacrocolpopexy videos or to compare the quality of videos on PubMed versus YouTube. OBJECTIVE: To compare the educational quality of minimally invasive sacrocolpopexy surgical videos available on two platforms, PubMed and YouTube, using the LAP-VEGaS VAT METHODS: A PubMed search was performed for videos of minimally invasive sacrocolpopexy, applying keywords to capture relevant surgical methods. The “Video Audio Media” filter was used to isolate video content. Videos that were schematic, animated, included concomitant procedures, or contained marketing for surgical equipment were excluded. Each PubMed video was then matched to one or more YouTube videos based on minimally invasive route and video length. To reduce confounders to YouTube’s search algorithm, a private browser was utilized. The PubMed keywords were searched on YouTube, then matched from video list ranked by “Relevance.” Two surgeons (YC and SH) independently scored the videos using the LAP-VEGaS VAT. A third surgeon (MR), masked to initial scoring, resolved scoring discrepancies. The average cumulative and item-specific scores were compared between PubMed and YouTube using an independent-samples t-test, assuming unequal variances with corrections for multiple comparisons where applicable. RESULTS: 18 PubMed videos and 19 YouTube videos published between 2009 and 2024 were reviewed (Table 1). The overall median video length was 7 minutes 38 seconds (range, 4 minutes 30 seconds to 9 minutes 58 seconds). Traditional laparoscopy was the most common route of surgery (n=17, 45.9%), followed by robotic-assisted (n=13, 35.1%) and a combination transvaginal/laparoscopic approach (n=7, 18.9%). The mean cumulative LAP-VEGaS VAT score was significantly higher for the PubMed videos (13.2±2.9, range 9–17) than the YouTube videos (9.7±3.7, range 2–18, p=.003). PubMed videos scored on average higher across all individual items, especially for quality of formal case presentation (Q2), clarity of demonstration of intraoperative findings (Q5), and presence of English-language audio/written commentary (Q8) (Table 2). However, after correcting for multiple comparisons, these differences were not statistically significant. CONCLUSIONS: Educational surgical videos depicting minimally invasive sacrocolpopexy identified by PubMed search were of higher overall educational quality than those found on YouTube when evaluated with the LAP-VEGaS VAT. Restricted free access to many PubMed publications presents a potential barrier to surgeon ongoing medical education, particularly those working outside academic settings. Our findings highlight the importance of advocacy for increased access to publicly available peer-reviewed surgical content.Table 1Table 2

Surgery residents often consider learning from the operative videos on YouTube, however, the quality of these videos is questionable. We aim to compare the quality and reliability of operative videos on thoracoscopic lobectomy (TL) in children available on YouTube (YT) and WebSurg (WS). Using a defined search strategy, the most-viewed YT videos and all available WS videos on TL in children were identified. The quality and reliability of the two groups of videos were compared using the video popularity index (VPI), Journal of American Medical Association (JAMA) benchmark criteria, and LAP-VEGaS quality assessment tool. On the basis of the LAP-VEGaS score, the videos were divided into acceptable quality (score ≥ 11) or poor quality (score < 11). Ten most-viewed YT videos were compared with six relevant videos on WS. The median %VPI among the WS and YT videos were 83.3 (range 71.5-404.4) and 49.4 (range 0-270), respectively (p = 0.017). The median JAMA score of the WS videos was also significantly higher than the YT videos (p = 0.0003). In terms of the LAP-VEGaS scores, all WS videos versus only three YT had an acceptable quality. As compared to the WS videos, the quality and reliability of the YT videos on TL were significantly poorer.

This article was migrated. The article was marked as recommended. Videos are increasingly used in medical education. They are effective for teaching difficult-to-grasp concepts that rely heavily on visuospatial processing ability such as anatomy, surgical procedures, and physical exam maneuvers. Common pitfalls of existing videos include lackluster audiovisual quality, poor camera angles, absence of formal teaching as narration, or excessive length. This article serves to assist educators who wish to produce educational clinical encounter videos that maximize student learning. We detail 12 tips focused on improving the quality of clinical educational videos, mitigating cognitive load within a video, and understanding the technicalities of video production. These tips are based on review of existing literature on neurocognitive learning theories and the succeeding Cognitive Theory of Multimedia Learning (CTML), as well as our experience in producing educational videos.

Background: The lack of consumer knowledge and misconception of services could impede requests for and acceptance of palliative care. YouTube has been widely used for health information dissemination. Objective: To explore the availability and characteristics of palliative care educational videos on YouTube and determine how palliative care is portrayed in these videos. Methods: Keyword search and snowball methods were used to identify palliative care videos on YouTube. A structured data collection protocol was developed to record characteristics of a video. Descriptive analysis was used to describe the video features; logistic regression was conducted to determine the association between video characteristics and number of views per day. Results: A total of 833 videos were screened; 84 met criteria for analysis. The most prominent video styles were providing palliative care information (85%) and personal testimony (50%). One-third were uploaded by hospice/palliative care services or medical organizations, while another one-third by advocacy organizations. More than two-thirds mentioned "end-of-life" and 35% mentioned "hospice." Physicians most frequently appeared and served as protagonists. Protagonists were primarily female (71.0%), aged 18-64 years (81.7%), and white (90.3%). Compared with videos uploaded by health care agencies, those uploaded by advocacy organizations had 6.41 times higher odds of having more than one view per day (p = 0.002). Conclusion: Online videos may not provide accurate and appropriate information on palliative care. There is minimal ethnic diversity in terms of physician and family representation. More research is needed to determine the effectiveness of these videos in improving consumer knowledge of palliative care.

In a recent letter to the Aesthetic Surgery Journal , “Can We Really Control the Inframammary Fold (IMF) in Breast Augmentation?” Dr Swanson made claims regarding the inability to control the IMF during primary breast augmentation.1 We were surprised by the comment and almost decided not to respond, however, we decided to offer the following. Controlling IMF position and nipple: fold length is the single most important aspect of breast surgery and is often disregarded. The surgeon, who pays no attention to this philosophy, is sure to have poor results; and the surgeon, who makes this a priority, will enhance results; however, controlling the IMF can never be 100% successful as many variables exist, the most unpredictable being – living tissue. Our clinical practice has demonstrated an easily adaptable, low-risk, three-point IMF suture …

Subfascial breast augmentation is becoming popular because of a better understanding of breast anatomy. However, because the subglandular approach is also another popular method, it is critical to assess the influence of the superficial fascia of the pectoralis major muscle on the subfascial and subglandular pockets to determine if one method is superior to another. This study investigated whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Twenty patients were recruited, and each was randomly sorted to the subfascial and/or subglandular pocket per breast. Both patients and surgeons were blinded. Differences were evaluated through five independent surgeons and by magnetic resonance imaging scans. Subsequently, 1-year and 5-year follow-ups were conducted. The results of the 5-year follow-up considering the aesthetics of the breast contour were significantly different between groups, with more good and excellent evaluations in the subfascial group. Regarding breast shape, there were also statistical differences, also with more good and excellent evaluations in the subfascial group. For breast consistency, subglandular had 84.20 percent of patients classified into Baker I and II, whereas subfascial had 100 percent. Magnetic resonance imaging scans showed a smaller implant base in the subglandular pockets, which was a significant result. There were no significant differences in implant projection. Comparison of the number of folds revealed significant differences between groups, with more folds in the subglandular group. Statistical differences between methods were found regarding breast shape and contour, capsular contracture, implant base, and the number of folds, showing that subfascial breast augmentation is superior to subglandular breast augmentation. Therapeutic, II.

We present a case report of a patient who experienced a late, spontaneous breast hematoma 26 years after primary breast augmentation. Late hematomas are a rare complication of breast augmentation with uncertain etiology. In this case, there was no trauma, calcifications, or implant rupture. We believe the patient’s hematoma was secondary to erosion of a capsular vessel due to capsular contracture.