> ## Content Index
> Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt
> Use this file to discover other available public pages before exploring further.

# Waitlist Closing, JPRAS Journal Club + Breast Implant Everything.
- URL: https://www.theplasticsfella.com/may-25th/
- Published: 2025-05-23T19:03:53.000Z
- Updated: 2025-05-24T20:18:07.000Z
- Description: Also: BIA-ALCL signs, the Sunday quiz, & 3 recommended reads.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/may-25th/#a-letter-from-pfella)  
You Don’t Need More Content. You Need the Right Framework
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/may-25th/#the-sunday-quiz)  
How well do you know breast ptosis.
3. 🖼️ [****Image of the Week**](https://www.theplasticsfella.com/may-25th/#image-of-the-week)  
Clinical presentation of BIA-ALCL.
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/may-25th/#technique-tip)  
Breast implant placement options.
5. 🎓 [****JPRAS Journal Club**](https://www.theplasticsfella.com/may-25th/#jpras-journal-club)  
Breast implant illness and its comorbid conditions.
6. 📘 [****Foundations Textbook**](https://www.theplasticsfella.com/may-25th/#foundations-textbook)  
Last call for the waiting list!
7. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/may-25th/#articles-of-the-week)  
Surgeon awareness of BIA-ALCL, history of breast implants, & choosing breast implants: with 1-sentence summaries.
8. 💕 [****Feedback**](https://www.theplasticsfella.com/may-25th/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

****You Don’t Need More Content. You Need the Right Framework**

👋

****Do you agree?**  
  
Some days, it feels like learning plastic surgery is less about curiosity and more about navigating clutter.  

  
You start off with good intentions. Maybe it’s to revise flaps, brush up on anatomy, or prep for tomorrow’s list. But five minutes in, you’re buried in a maze of half-finished PDFs, conflicting explanations, and lecture recordings with no timestamp on what actually matters.

And no one really teaches you how to make sense of it all. The volume grows. The structure never comes. And somehow, we call this learning.

### What Most of Us Are Missing

If you’ve ever felt like you’re working harder than necessary just to get a basic grasp of something, you’re not alone. What’s missing usually isn’t motivation or intelligence...it’s a system.

A clear way of thinking.  
A framework that says: this is the core, this is how it connects, and this is where to go next.

### What We’re Working On

We’ve been exploring this exact issue for a while now. How to bring order to the chaos without oversimplifying. How to teach the fundamentals without flattening the nuance.

The result is something we’ve been quietly building in the background. A structured way of learning, designed with the same discipline we bring to surgery itself. 

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/05/Screenshot-2025-05-24-at-21.13.11-1.png)

[Source](https://foundations.theplasticsfella.com/?ref=theplasticsfella.com)

[Waitlist Closes Tomorrow](https://foundations.theplasticsfella.com/?ref=theplasticsfella.com)

No pressure. No hard sell. Just something that might make things a little clearer.

With love,  
P Fella ❤️

## The Sunday Quiz

**How Well Do You Know Implant Ptosis*

****Ready to climb the leaderboard?**  
  
Join **The Weekly Quiz* in each edition of thePlasticsPaper. Tackle one question per week for seven rounds!  
  
The ****top** scorer wins a copy of our upcoming textbook, [**Foundations*](https://foundations.theplasticsfella.com/?ref=theplasticsfella.com).

## Image of the Week

**Clinical Presentation of BIA-ALCL*

🖼️

****Image of the Week**   
  
This week’s image features a classic clinical presentation of ****BIA-ALCL:** A late-onset seroma causing visible asymmetry and swelling in a patient with textured breast implants.  
  
Key points:  
****1\.** Most common presentation: delayed peri-implant effusion (typically >1 year post-op).  
****2.** May also present with capsular contracture, mass, or regional lymphadenopathy.  
****3\.** Diagnosis requires ultrasound-guided aspiration and CD30-positive, ALK-negative cytology.  
  
Prompt recognition and referral for oncologic assessment and en bloc capsulectomy are crucial.

![Clinical presentation of BIA-ALCL](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/05/image-5.png)

Clinical presentation of BIA-ALCL

## Technique Tip

**Breast Implant Placement Options*

🚑

****Technique Tip of the Week**   
  
This week’s tip breaks down the key differences between subglandular, subfascial, and dual plane breast implant placements, each with distinct clinical pros and cons.  
  
📌 Quick comparison:  
****1\. Subglandular:** Simple access, no animation deformity, but higher risk of palpability and capsular contracture.  
****2\. Subfascial:** Reduced animation, lower contracture rates vs. subglandular, though technically more demanding.  
****3\. Dual Plane:** Optimal lower pole fill and soft tissue coverage, but requires IMF access and greater surgical precision.

![Differences between subglandular, subfascial, and dual plane breast implant placements](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/05/image-6.png)

Differences between subglandular, subfascial, and dual plane breast implant placements

## JPRAS Journal Club

**Breast Implant Illness and Its Comorbid Conditions*

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/05/Lunchtime-Lessons-1.webp) 

#### ****Exploring Breast Implant Illness and its Comorbid Conditions: A Systematic Review & Meta-Analysis**

Data from a systematic review show that ****49%** of 7045 patients with ****breast implants** reported symptoms consistent with Breast Implant Illness (****BII**), most commonly ****fatigue**, ****joint pain**, and ****brain fog**.   
  
Symptom improvement followed by explantation in over half of the cases. Autoimmune, psychiatric, and oncologic comorbidities were frequently observed. ****Clear diagnosis remains challenging**, highlighting the need for patient-centred care, thorough assessment, and shared decision-making.

[Read More](https://www.theplasticsfella.com/journal-breast-implant-illness/) 

## Foundations Textbook

**Last Call for the Waiting List!*

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/05/image--6-.png)

**Foundations* waitlist deadline extended

📙

****Last 24-hour call!**  
  
Your response to the **Foundations* waitlist has been amazing, and there are still many of you signing up. So we decided to extend our waitlist closing date to ****May 26th** at 11:59 PM EST. Don't miss out on this **final chance to secure early access**.  
  
**Foundations* is designed to be the only textbook that evolves as our field grows. We are here to make a change in medical education and invite you to be a part of it!   
  
This isn’t just about innovation. It’s about necessity. Plastic surgery moves fast. The resources we learn from should too.  
  
****Sign up for the waitlist below!**

[Reserve Your Copy!](https://foundations.theplasticsfella.com/?ref=theplasticsfella.com#reserve-copy)

## Articles of the Week

**3 Interesting Articles with One-Sentence Summaries*

✅

****Surgeon Practices Shift in Response to BIA-ALCL Awareness Across Europe** ([Santanellidi Pompeo](https://www.jprasurg.com/article/S1748-6815%2824%2900712-5/fulltext?ref=theplasticsfella.com), 2025)  
  
Surgeon awareness of BIA-ALCL has driven a shift from macrotextured to smooth implants, with many also reporting changes in patient counseling and greater consideration of autologous reconstruction.

✅

****Historical Evolution and Safety Controversies of Breast Implants** ([Santanelli di Pompeo](https://www.jprasopen.com/article/S2352-5878%2822%2900013-4/fulltext?ref=theplasticsfella.com), 2022)  
  
The evolution of breast implants was shaped by innovations in filler and shell design, regulatory interventions, and safety crises, including capsular contracture, PU degradation, PIP fraud, and BIA-ALCL.

✅

****Decision Making in Breast Implant Selection for Reconstruction** ([Eijsink](https://www.jprasopen.com/article/S2352-5878%2823%2900071-2/fulltext?ref=theplasticsfella.com), 2023)  
  
Breast implant selection varies widely and is influenced by both evidence and non-clinical factors, including frequent patient-driven deviations, which highlights the need for shared decision making.

## Feedback

### I hope you enjoyed it 😄

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