May 2026 Edition
- thestitchprs
- May 1
- 7 min read
10 min read
Welcome to the May edition of The Stitch. This month’s issue highlights the expanding role of plastic surgery beyond traditional boundaries, explores the historical roots that continue to shape our field today, and examines the critical intersection between surgical practice and patient psychology.
From interdisciplinary collaboration in complex surgical care to the ethical nuances of aesthetic decision-making, this edition emphasizes the breadth, adaptability, and responsibility inherent to plastic surgery.
We hope this issue encourages you to think beyond the operating room, appreciate the legacy that informs our practice, and reflect on the evolving role of plastic surgeons within modern medicine.
The Stitch Editorial Board
Beyond the Specialty: The Expanding Role of Plastic Surgery Across Disciplines
Article by Virginia Bailey, Florida State College of Medicine Class of 2027
Plastic surgery at its core, utilizes creative problem solving to restore form and function. The principles we use daily such as flap design, microsurgery, tissue handling, vascular anastomosis, and spatial reasoning, are highly transferable skills. These skills are increasingly shaping outcomes across multiple surgical specialties.
One striking example is in cardiac surgery. In “Outcomes following coronary artery bypass grafting with microsurgery in paediatric patients,” Shafarenko et al. present a single-institution retrospective review comparing pediatric coronary artery bypass grafting (PCABG) performed with and without microsurgical techniques (1). Among 24 patients, the subgroup requiring microsurgical involvement, typically younger patients with smaller-caliber vessels, demonstrated no anastomotic complications, no perioperative mortality, and remained asymptomatic at follow-up despite greater technical complexity (1). These findings highlight the potential benefit of incorporating microvascular surgical expertise into pediatric cardiac procedures, suggesting that interdisciplinary collaboration may improve technical outcomes and reduce complications, particularly in high-risk or anatomically challenging cases.
Similarly, in “Feasibility and Safety of Arterial Transfer for Microscopic Hepatic Artery Reconstruction After Hepatobiliary and Pancreatic Tumor Resection,” Katayama et al. evaluate arterial transfer (AT) as an alternative technique for hepatic artery reconstruction (2). In a retrospective cohort of 130 patients, AT was utilized in 43% of cases and demonstrated outcomes comparable to direct anastomosis (DA), with no significant differences in complication rates, thrombosis, or five-year overall survival (2). Notably, reconstruction was achieved without graft interposition in over 99% of cases, underscoring AT as an effective option when DA is not feasible.
The study highlights the importance of microsurgical collaboration in hepatobiliary oncology and suggests that AT can maintain adequate hepatic perfusion without increasing perioperative risk.
Both of these procedures require the same skillset applying basic plastic surgery principles of delicate handling of vessels, adaptability in anatomy, and meticulous anastomotic technique.
By stepping beyond traditional boundaries and offering their expertise across specialties, plastic surgeons can be strong stewards within the hospital and can offer skills to even cardiac and hepatobiliary services. Even more importantly, as healthcare becomes increasingly value-driven, plastic surgeons who actively collaborate across specialties position themselves as essential partners and helps strengthen the role of plastic surgery within the institution.
References:
Shafarenko MS, Catapano J, Luo S, Zuker RM, Van Arsdell G, Borschel GH. Outcomes following coronary artery bypass grafting with microsurgery in paediatric patients. Interact Cardiovasc Thorac Surg. 2018;27(1):27-33. doi:10.1093/icvts/ivx419
Katayama R, Yasunaga Y, Akazawa S, et al. "Feasibility and Safety of Arterial Transfer for Microscopic Hepatic Artery Reconstruction After Hepatobiliary and Pancreatic Tumor Resection". Plast Reconstr Surg. Published online October 30, 2025. doi:10.1097/PRS.0000000000012582
Have You Ever Wondered What the Meaning of the PSRC Sheep Logo Is?
Article by Virginia Bailey, Florida State College of Medicine, Class of 2027
The iconic Plastic Surgery Research Council sheep logo pays tribute to one of the earliest pioneers of tissue transplantation. In 1804, Italian physiologist Giuseppe Baronio conducted a series of meticulous experiments on sheep, transplanting skin between different areas of the body and carefully documenting the healing process and graft survival. Through this work, Baronio demonstrated a groundbreaking concept; that tissue could survive and integrate when transferred to a new location within the body.
He is now recognized as a foundational figure in transplantation science, and his work laid the groundwork for modern reconstructive surgery. Today, Baronio’s sheep stands as a symbol of innovation, curiosity, and scientific discovery. The PSRC logo embodies the origins and enduring spirit of plastic and reconstructive surgery.
References
Randall P. The Plastic Surgery Research Council Thirty-Five Year History. Plastic Surgery Research Council. Plastic Surgery Research Council. Accessed April 29, 2026.
Plastic Surgery Research Council. Guiseppe Baronio and the Sheep. PSRC Sheep Page. Accessed April 29, 2026.
When Surgery Isn't the Solution: Navigating Body Dysmorphia in Aesthetic Patients
Article by Fatima Khan, University of Toledo College of Medicine, Class of 2027
A cosmetic surgery consultation often begins with a request. Some wish to address changes after pregnancy or weight loss. Others hope to soften visible signs of aging, improve symmetry, or correct a feature that has bothered them for years. In many cases, patients have realistic goals and experience meaningful satisfaction. Cosmetic procedures can improve confidence, restore comfort after life changes, and help patients feel more aligned with how they see themselves. Yet sometimes, beneath the request for physical change lies a deeper form of distress.
Plastic surgery exists at a unique intersection of anatomy, identity, and psychology. Surgeons are not only asked to reshape physical features, but to navigate the emotions and expectations attached to them. This is especially important when evaluating patients who may be struggling with Body Dysmorphic Disorder (BDD). In these moments, the consultation becomes far more than a discussion of risks, benefits, and recovery time: it becomes a test of judgment, empathy, and ethical restraint.
BDD is a mental health condition characterized by a persistent preoccupation with flaws in appearance that may be minor or not noticeable to others. These concerns can create severe emotional distress and impair daily functioning. Patients may spend excessive time checking mirrors, comparing themselves to others, seeking reassurance, avoiding social situations, or pursuing repeated procedures without satisfaction. Even after a technically successful operation, the distress often remains because the true problem was never the nose, chin, skin, or waistline alone.
A patient with unrealistic expectations may believe surgery will save a relationship, transform a career, erase years of insecurity, or create perfection. When these expectations are unmet, disappointment can follow even when the surgical result is objectively strong. This is why cosmetic surgery requires more than operative talent. It demands emotional intelligence, communication skills, and the ability to evaluate whether a procedure is truly likely to help the person sitting in front of you. Sometimes, the most important diagnosis in the room is not found on physical exam.
For this reason, validated assessment tools can play an important role in the consultation process. They provide a more structured way to identify patients who may have an unidentified diagnosis of BDD and who may be less likely to benefit from surgery. While the formal diagnostic gold standard for BDD is a lengthy psychiatric interview that may be impractical in a busy clinic, shorter screening tools such as the Body Dysmorphic Disorder Questionnaire-Dermatology Version and Dysmorphic Concern Questionnaire offer practical alternatives in cosmetic settings.
Plastic surgery is often misunderstood as a field focused only on appearance. In reality, it is a specialty deeply rooted in restoring form, function, and quality of life. The best surgeons understand that confidence cannot always be sculpted, and self-worth cannot be sutured into place. A procedure may refine a feature, restore contour, or rejuvenate appearance. But when distress is rooted deeper than anatomy, the scalpel has limits. Knowing when to operate is important and knowing when not to may be even more so.
References
Danesh M., Beroukhim K., Nguyen C., Levin E., Koo J. Body dysmorphic disorder screening tools for the dermatologist: A systematic review. Pract Dermatol. 2015;2:44–49.
Higgins S, Wysong A. Cosmetic Surgery and Body Dysmorphic Disorder - An Update. Int J Womens Dermatol. 2017;4(1):43-48. Published 2017 Nov 20. doi:10.1016/j.ijwd.2017.09.007
Joseph A.W., Ishii L., Joseph S.S., Smith J.I., Su P., Bater K. Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg. 2016;19:269–274. doi: 10.1001/jamafacial. 2016.1535
Exploring the Cosmetic Surgery Paradox: Where Plastic Surgery and Feminism Intersect
Article by Nicolette Bullard, University of South Florida, Class of 2027
Aesthetic surgery and feminism have both seen explosive growth over the past two decades, and at their intersection lies one of medical ethics' most layered ongoing conversations. The Stitch between the two is far from simple- it may be contradictory, mutually reinforcing, or perhaps both at once.
Aesthetic procedural volume has increased by 40% in just four years, with nearly 35 million procedures performed in 2023 alone, driven by social media, evolving beauty standards, increased access, and generational shifts in attitudes toward cosmetic enhancement.
Feminist thought has grappled with cosmetic surgery across multiple waves. Earlier discourse framed it as a patriarchal tool designed to satisfy the male gaze. Third wave and "choice feminism" reframed it through the lens of autonomy — the right of women to make decisions about their own bodies, with surgery as a potential act of empowerment rather than submission.
This ongoing tension has been described as the “cosmetic surgery paradox.” Despite its increasing prevalence, aesthetic surgery can still carry elements of social stigma. At the same time, the cultural standards that contribute to its demand may also shape perceptions of those who pursue it. While body positivity is widely promoted, its application is not always consistent. In practice, many patients pursue aesthetic procedures not out of pressure, but out of a desire to
feel more aligned with their own self-image.
For plastic surgeons, engaging with these perspectives is clinically relevant. The same procedure may represent restoration, confidence, or self-expression for one patient, and something entirely different for another. Approaching each patient’s motivations with openness and without judgment is central to ethical, patient-centered care- and underscores the importance of upholding principles of autonomy and justice within modern aesthetic practice. Importantly, these ideas are not mutually exclusive. Aesthetic surgery can exist within broader cultural frameworks while also serving as a meaningful avenue for individual agency and well- being. Recognizing this complexity allows for a more balanced and constructive dialogue.
Continued engagement with topics at the intersection of body image, societal influence, and plastic surgery is essential—not only to thoughtful discourse, but to the ongoing advancement and integrity of the field.
References
Triana, L., Palacios Huatuco, R. M., Campilgio, G., & Liscano, E. (2024). Trends in Surgical and Nonsurgical Aesthetic Procedures: A 14-Year Analysis of the International Society of Aesthetic Plastic Surgery-ISAPS. Aesthetic plastic surgery, 48(20), 4217–4227. https://doi.org/10.1007/s00266-024-04260-2
Bonell, S., Barlow, F. K., & Griffiths, S. (2021). The cosmetic surgery paradox: Toward a contemporary understanding of cosmetic surgery popularisation and attitudes. Body image, 38, 230–240. https://doi.org/10.1016/j.bodyim.2021.04.010
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