FBI Stops Simultaneous Surgery, Final Week of the Sunday Quiz, & Melanomas

Also: Upcoming podcast episode and a new article on gynaecomastia.
FBI Stops Simultaneous Surgery,  Final Week of the Sunday Quiz, & Melanomas

In this week's edition

  1. ✍️ Letter from P'Fella
    FBI stops simultaneous surgery.
  2. 🤓 The Sunday Quiz + Leaderboard
    How well do you know melanomas?
  3. 🎙️ Behind the 'Fella
    Sneak peek from episode 03: All things research.
  4. 🎓 theFellow's Corner
    Fresh drop: Gynaecomastia pathophysiology, diagnosis, & treatment.
  5. 📖 What Does the Evidence Say?
    Adjuvant therapies in melanoma.
  6. 🔥 Recommended Articles of the Week
    Lymph node dissection, excision margins for thick cutaneous melanoma, & margins for primary cutaneous melanoma; with 1 sentence summaries.
  7. 💕 Feedback
    Suggest ideas & give feedback!

A Letter from P'Fella

FBI Stops Simultaneous Surgery

Hey Team!

Big news: the FBI investigated a Medical Center, accusing three heart surgeons of running two ORs at once and letting residents handle complex surgeries. Let's break it down:


Experienced surgeons often differentiate between aspects of surgical procedures that require their expertise and those that can be managed by senior residents or fellows. The practice of running multiple operating rooms simultaneously is usually designed to treat more patients efficiently.

These "surgical trainees" are often not novices; they are often fully trained fellows who require real surgical experience to refine their skills. However, the absence of hands-on practice could compromise future patient care. There is a significant debate surrounding this practice. Critics argue that entrusting complex parts of surgeries to residents could be risky, especially as modern medicine increasingly prioritizes safety and quality, which makes this practice controversial.

Patients typically provide informed consent, acknowledging the involvement of trainees in their surgeries. However, questions remain about the actual qualifications of these residents and whether patients fully understand the extent of trainee involvement.

The involvement of the FBI raises further questions. Typically, state medical boards are responsible for overseeing medical qualifications and practices, so why is a federal agency involved? This situation underscores the delicate balance between ensuring patient safety and providing necessary training to future surgeons—a balance that is crucial for the advancement and security of the medical field.

Let’s keep the conversation going!


The Sunday Quiz

How Well Do You Know Melanomas?

Are you ready for the last round of The Weekly Quiz?

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 $100 voucher.

Melanoma - Definition

We're planning to discuss melanomas in an upcoming podcast episode. Subscribe on Spotify or Apple to listen once it's out!

Behind the ‘Fella

Sneak Peek from Episode 03

Tune in Now: "Behind the Fella"

Tune into our podcast for exclusive team meetings where we uncover behind-the-scenes details of the platform and discuss hot topics in plastic surgery with our fellows.

In this week's episode, we explore all things research!

You can now listen on Spotify & Apple.


Listen now on Spotify and Apple!

If there's any specific discussion you're interested in, let us know below.

the Fellows' Corner

This Week's Focus: Gynaecomastia

In case you've missed out, here's a reminder to check out our fresh articles, clinical cases, and surgical techniques.

Read below for an overview of our article on Gynaecomastia.


Gynaecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition.

Gynaecomastia is caused by an imbalance of androgenic and oestrogenic effects on the breast.

Clinical Features
Gynaecomastia presents as bilateral, firm, concentric, and painless enlargement of the male breast.

Simon's classification is based on the degree of tissue and skin excess and Cordova is based on structural components of the breast. Gynaecomastia is staged using the Rohrich et al staging system.

Evaluation of gynaecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging, and tissue sampling.

Treatment options include weight loss, reassurance, pharmacotherapy, and surgical resection or liposuction.

Complications of surgical excision include NAC loss, deformity, over/under resection, scarring, and recurrence.

Read the Article

What Does the Evidence Say?

Adjuvant Therapies in Melanoma

In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques.

Major adjuvant trials have shown significant survival benefits for patients with resected Stage III melanoma.

  • EORTC 18,201 demonstrated that ipilimumab significantly improved 5-year recurrence-free (40.8% vs. 30.3%) and overall survival (65.4% vs. 54.4%) compared to placebo.
  • CheckMate 238 found nivolumab more effective than ipilimumab, with a 24-month relapse-free survival rate of 70.5% versus 63.7%.
  • Combi-AD revealed that dabrafenib plus trametinib greatly reduced metastasis risk, achieving a 3-year relapse-free survival of 59% compared to 39% for placebo.
  • EORTC 1325/KeyNote 054 showed pembrolizumab increased recurrence-free survival to 75.4% versus 61% for placebo.
  • BRIM-8 indicated a modest effect of vemurafenib on disease-free survival in Stage IIC-III melanoma.

These studies confirm the efficacy of adjuvant therapies in improving outcomes for this patient group.

Articles of the Week

3 Interesting Articles with 1 Sentence Summaries

Is lymph node dissection essential for melanoma with sentinel-node metastasis? (Faries, 2017)

Immediate completion lymph node dissection in melanoma patients with sentinel-node metastases did not enhance melanoma-specific survival compared to nodal observation, but improved regional disease control and offered valuable prognostic insights, albeit with a higher risk of lymphedema.

Which surgical excision margins are more effective for thick cutaneous melanoma? (Utjés, 2019)

A long-term study comparing 2-cm and 4-cm surgical excision margins for thick cutaneous melanoma found that both margins provide similar overall and melanoma-specific survival rates, suggesting that the narrower 2-cm margin is sufficient for effective treatment.

Comparison of a 1-cm surgical margin and a 2-cm margin for treating primary cutaneous melanoma (Moncrieff, 2018)

A pilot study (MelMarT) compared 1-cm and 2-cm surgical excision margins for primary cutaneous melanoma thicker than 1 mm, finding that both margins were feasible, with no significant differences in patient quality of life.


I hope you enjoyed it 😄

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