In this week's edition
- ✍️ Letter from P'Fella
Shifting from mere courses to competence: The Skill School manifesto. - 🤓 The Sunday Quiz
How well do you know breast recon? - 🖼️ Image of the Week
Classic implant capsular contracture - 🚑 Technique Tip
Meticulous DIEP Perforator Dissection - 📘 Foundations Textbook
Foundations referral system - coming soon! - 🎈 Upcoming Events
New breast surgery events added. - 🔥 Articles of the Week
Oncoplastic recon, PRS CME, and DIEP Original Case Series. - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
Shifting From Mere Courses to Competence: The Skill School Manifesto
The response wasn’t only positive, it was loud too. Surgeons from every stage of training and from every corner of the world share the same idea:
“I’m not done learning, but I’m done pretending weekend courses make me better.”
And that’s exactly the gap we’re trying to fill.
So, we’re building something. Together.
Not a weekend high. Not another certificate. Not a course you forget a month later.
From your survey responses, a few themes were crystal clear:
- You want accountability: Because real learning requires someone holding the mirror.
- You want repetition: Not once. Not twice. Enough times that it becomes automatic.
- You want mentorship that lasts: The kind that evolves as your skill evolves.
- You want real measures of progress: Not “you’ll be fine,” but “here’s what improved and here’s what still needs work.”
- You want a motivated community: A place where everyone is trying to get better. Not to just perform, impress, or collect certificates.
We’re exploring what a Skill School could look like. Something designed from the ground up to help surgeons actually improve, retain, and refine their skills over time.
Think of it as the opposite of a crash course. A Skill School is slow, deliberate, and honest. It asks more of you, but it gives more back.
We’re imagining a system where:
- You don’t just learn a technique, you revisit it until it sticks.
- Feedback isn’t generic and vague. It’s built in to track your performance.
- Mentorship is ongoing with support where you need it.
- Your progress is visible to you and your faculty.
- You become part of a motivated, accountable community.
If we’re going to build a Skill School that actually works, it needs to solve your problems, not our assumptions.
So, let us know how a Skill School can serve you 👇
With love,
P’Fella ❤️
The Sunday Quiz
How Well Do You Know Breast Recon?
Join this fresh round of our Weekly Quiz in each edition of thePlasticsPaper. This is the first round of seven rounds!
The top scorer wins our Foundations textbook at a discount!
Image of the Week
Wise‑Pattern Oncoplastic Reduction for Lower Pole Tumour
Clinical example of severe capsular contracture — note the high-riding, distorted breast mound and visible firmness from pathologic capsule tightening. In panel B, the highlighted area marks the inferior pole deficit, where the contracted capsule pulls the implant upward and restricts natural contour.
Technique Tip
How to Dissect the DIEP Perforator
A clear walkthrough of DIEP perforator dissection — identifying reliable perforators, protecting motor nerves, and separating vessels from the rectus muscle to preserve strength. Watch how meticulous perforator dissection ensures a well-perfused flap with minimal donor-site morbidity.
Foundations Textbook
Foundations Referral System - Coming Soon!
We’re about to open a referral system for people who use Foundations for their daily practice and want to share it with colleagues in a trackable way.
The plan:
- You’ll get a unique referral link as an existing user.
- Colleagues who use it will get a small discount.
- For each purchase via your link, you’ll get a small reward.
This referral system is simply us formalising what the community is already doing and giving you some credit for it.
You'll receive the full details (and your link) in the next couple days, so keep an eye out on your inbox. As always, thanks for being with the P'fella and growing with us!
Upcoming Events
New Breast Surgery Events Added
Articles of the Week
3 Interesting Articles with One-Sentence Summaries
Longer delays to final breast reconstruction are linked to lower quality-of-life scores, but the drop only becomes clinically meaningful with very long waits. Fact: Patients with BMI ≥35 kg/m² waited the longest median 936 days.
Prepectoral breast reconstruction avoids muscle dissection, and this review outlines who benefits, how implant/mesh choices affect outcomes, and how to revise complications. It provides a practical, controversy-focused framework with current evidence rather than just a standard overview.
The original DIEP flap paper shows you can reconstruct a breast using lower-abdominal skin and fat without sacrificing muscle, reducing hernia and weakness risks. Fact: In this early series, 15 breasts were successfully reconstructed using perforators alone.
