> ## 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.

# 6 Traits of Patients Who Sue Surgeons, Trending Nipple Fillers, & Cosmetic Breast Insights
- URL: https://www.theplasticsfella.com/november-24th/
- Published: 2024-11-22T18:49:32.000Z
- Updated: 2024-12-07T17:46:45.000Z
- Description: Also: The Sunday quiz, breast reduction technique tip, & 3 recommended reads.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/november-24th/#a-letter-from-pfella)  
SIMON will be disappointed, but FATIMA might sue you.
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/november-24th/#the-sunday-quiz)  
**Final round:* How well do you know **breast augmentation?*
3. [🖼️](https://emojipedia.org/framed-picture?ref=theplasticsfella.com) [****Image of the Week**](https://www.theplasticsfella.com/november-24th/#image-of-the-week)  
Classification of breast ptosis.
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/november-24th/#technique-tip)  
How to do a breast reduction: Learn from Madeline Lejour's herself.
5. ****👁️** [****What's Trending?**](https://www.theplasticsfella.com/november-24th/#whats-trending)  
Injectable nipple fillers are trending at the moment!
6. 📖 [****What Does the Evidence Say**](https://www.theplasticsfella.com/november-24th/#what-does-the-evidence-say)  
A combined augmentation-mastopexy or two-stage?
7. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/november-24th/#articles-of-the-week)  
Subfascial vs. subglandular breast augmentation, breast implant illness, & BIA-ALCL and textured breast implants: with 1 sentence summaries.
8. 💕 [****Feedback**](https://www.theplasticsfella.com/november-24th/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**SIMON Will Be Disappointed, But FATIMA Might Sue You*

👋

****Hey there!**  
  
Let's talk about two acronyms that have defined risk assessment in plastic surgery: ****SIMON** and ****FATIMA**. These aren’t just names — they’re essential tools for identifying patients who might become a nightmare post-op.

**Meet SIMON**

Back in 1999, Gorney and Martello gave us **SIMON:** **Single, Immature, Male, Over-expectant, Narcissistic**. SIMON patients were the ones you didn’t want to see on your schedule — likely to have unrealistic expectations and more likely to be dissatisfied no matter how perfect the surgery. SIMON was a way to spot those warning signs early before they turned into lawsuits or endless complaints.

**Now Meet** [**FATIMA**](https://link.springer.com/article/10.1007/s00266-024-04476-2?ref=theplasticsfella.com)

Fast forward to today, and we have [**FATIMA**](https://link.springer.com/article/10.1007/s00266-024-04476-2?ref=theplasticsfella.com), based on real litigation data from Spain. This acronym identifies traits common in plaintiffs who sue after plastic surgery:

- **F**emale
- Using **A**ntidepressants or Anxiolytics
- **T**attoos
- Breast **I**mplants
- **M**iddle-aged
- **A**ccess to free legal services

FATIMA is about being proactive. It’s not about rejecting patients but about recognizing potential risks and managing them effectively — keeping communication clear and expectations realistic.

**Why It Matters**

Whether it's SIMON or FATIMA, the message is clear: managing expectations is just as important as surgical skills. Most legal issues don’t arise from technical mistakes—they come from patients feeling let down or misinformed. These acronyms are a way to help us navigate that delicate balance.

Sure, these labels might feel harsh or simplistic, but they exist for a reason: to protect both the patient and the surgeon. If you know you’re dealing with a FATIMA, you can take extra steps to ensure everything is clear and understood—before anyone gets near the OR.

**What Do You Think?**

Have you encountered a SIMON or a FATIMA in your practice? Do you think these acronyms help or hurt when it comes to patient care? Share your thoughts!

With love,  
P'Fella ❤️

## The Sunday Quiz

**How Well Do You Know* ***Breast Augmentation**?

****Are you ready to make it to the leaderboard?**  
  
Welcome to ****the final 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. 

![Overview of breast augmentation - surgical incisions](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/11/image-9.png)

Overview of breast augmentation - surgical incisions

## Image of the Week

**Classification of Breast Ptosis*

🖼️

****Image of the Week**   
  
In this section, we feature an anatomical illustration. This edition looks at the classification of breast ptosis.   
  
Read more [here](https://www.researchgate.net/figure/Artists-depiction-of-the-breast-ptosis-grading-system-proposed-by-Regnault-et-al%5Ffig1%5F323733586?ref=theplasticsfella.com). 

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/11/Artists-depiction-of-the-breast-ptosis-grading-system-proposed-by-Regnault-et-al.png)

Pontell, Matthew & Noah, Harry & Brown, A. & Rose, M. & Ashinoff, R. & Saad, A.. (2018). [Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast](https://www.researchgate.net/figure/Artists-depiction-of-the-breast-ptosis-grading-system-proposed-by-Regnault-et-al%5Ffig1%5F323733586?ref=theplasticsfella.com). Plastic Surgery International. 2018\. 1-9\. 10.1155/2018/9205805.

## Technique Tip

**How to do a Breast Reduction*

🚑

****Technique Tip of the Week**   
  
This edition looks at Madeline Lejour's technique for marking a breast reduction.   
  
You can read more on the technique [here](https://x.com/PlasticsFella/status/1619408975623262208?ref=theplasticsfella.com). 

0:00 

/4:22 

1× 

Marking a breast reduction

## What's Trending?

**New Trend Spotted: Nipple Fillers*

👁️

In this section, we'll make sure you stay ahead of the curve with the latest techniques and hot topics in plastic surgery!  
  
This edition looks at injectable nipple fillers. Read the full article below 👇

[Injectable filler in your nipples? The latest trend in breast aestheticsIt seems like not that long ago, it was a significant faux pas to let a little nip slip through your blouse. If it was a cold day or the office cranked up the A/C, you better be wearing a thick bra or have packed a sweater to keep from embarrassing yourself with visible nipples showing through your shirt.![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/icon/apple-icon-180x180.png)American Society of Plastic SurgeonsAlia Willson![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/thumbnail/injectable-nipple-filler.jpg)](https://www.plasticsurgery.org/news/articles/injectable-filler-in-your-nipples-the-latest-trend-in-breast-aesthetics?utm%5Fsource=Twitter&utm%5Fmedium=Social&utm%5Fcampaign=PSEC)

## What Does the Evidence Say?

**Single-Stage vs Two-Stage Augmentation-Mastopexy*

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

****Should we do a combined augmentation-mastopexy or two-stage?**  
  
Simultaneous augmentation-mastopexy is a complex but increasingly popular procedure that combines breast augmentation with a lift. While some surgeons advocate for a ****two-stage approach** due to opposing force vectors (Kropf et al., 2011), several studies support the safety and efficacy of the one-stage procedure (Doshier et al., 2016; Stevens et al., 2014; Hedén, 2009; Swanson, 2013; Montemurro et al., 2019; Calobrace et al., 2013; Spring et al., 2015).   
  
Complication rates for the combined procedure range from 22.9% to 36.3%, with revision rates between 16.9% and 23.2% (Stevens et al., 2014; Swanson, 2013; Calobrace et al., 2013). These rates are comparable to or lower than the cumulative rates for separate procedures (Swanson, 2013).   
  
Common complications include ****poor scarring**, ****wound healing issues**, and ****recurrent ptosis** (Stevens et al., 2014; Calobrace et al., 2013). With proper patient selection, careful planning, and skilled surgical technique, simultaneous augmentation-mastopexy can be safely performed as a single-stage procedure with acceptable outcomes (Hedén, 2009; Spring et al., 2015).

## Articles of the Week

**3 Interesting Articles with 1 Sentence Summaries*

✅

****Comparison of Subfascial vs. Subglandular Breast Augmentation** ([Yuan](https://academic.oup.com/asj/article-abstract/44/9/NP639/7686579?redirectedFrom=fulltext&ref=theplasticsfella.com), 2024)  
  
Subfascial breast augmentation reduces capsular contracture, hematoma, and rippling compared to the subglandular plane, with 93% diagnostic agreement.

✅

****Breast Implant Illness: Insights, Patterns, and Controversies Explored** ([Kabir](https://academic.oup.com/asj/article-abstract/44/9/NP629/7651182?redirectedFrom=fulltext&ref=theplasticsfella.com), 2024)  
  
Breast Implant Illness (BII) symptoms were reported in 31.3% of patients, with 83.5% showing symptom improvement after implant removal, primarily in cosmetic rather than reconstructive cases.

✅

****BIA-ALCL and Textured Breast Implants: Guidelines for Improved Safety and Outcomes** ([Clemens](https://journals.lww.com/plasreconsurg/fulltext/2024/09000/american%5Fassociation%5Fof%5Fplastic%5Fsurgeons%5Fconsensus.2.aspx?ref=theplasticsfella.com), 2024)  
  
BIA-ALCL is linked to textured implants, necessitating surgeon awareness, patient surveillance, and adherence to evidence-based recommendations for diagnosis and management.

## Feedback

### I hope you enjoyed it 😄

---