We sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass, and hypothesized off-pump would be comparable to on-pump. Our primary outcome of interest was survival, and secondary outcomes included need for reintervention with new coronary stent, or new diagnosis of myocardial infarction (MI) occurring any time after surgery during the 8-12 year follow up period.

According to cisgender respondents, the "preferred" feminine breast has a 45:55 upper-to-lower pole ratio. Preferred breast ratios have not been evaluated for transgender women undergoing breast augmentation. Therefore, this study aimed to determine the preferred breast ratio according to the transgender population and, thus, better inform surgeon planning.

Methods

Patients diagnosed with gender dysphoria were sent a survey with morphed breast images of four different upper-to-lower pole ratios: 35:65, 45:55, 50:50, and 55:45. Respondents ranked the images according to aesthetic preference. Rankings were analyzed by the Condorcet method.

Results

298 survey responses were analyzed: 197 (66.1%) respondents identified as transgender women and 31 (10.4%) as transgender men. Most respondents were younger than 40 (64.8%). Eighty-one (27.2%) had undergone breast augmentation, 136 (45.6%) had not and were not considering it, and 81 (27.2%) had not but were considering it. Across all subgroups, the most preferred ratio was 45:55 (P = 0.046). Those with more masculine genders and assigned female at birth preferred the 45:55 and 50:50 ratios equally. Those in their 30's and younger preferred the 45:55 and 50:50 ratios equally.

Conclusions

The 45:55 ratio, established as the most preferred morphometrics for breast augmentation by cisgender respondents, is also the most aesthetically preferred proportion among transgender patients. Interestingly, the 50:50 ratio, which projects a larger upper bust compared to the 45:55 ratio, may be equally or more appealing to younger patients and those with more masculine genders. We hope these results improve patient-physician shared decision-making and postoperative expectations.

Background Today, patients can access a myriad of information sources regarding plastic surgery procedures prior to meeting with a surgeon. Despite their widespread use, the role of these sources in a patient's decision-making remains undefined. We hypothesized that the physician remains the key information source for patients making surgical decisions in plastic surgery, but that other sources may deliver important insights and prove helpful to varying degrees. We also explored motivations for this outside information search and any differences in perceived value among patients. Methods We administered a survey regarding various information sources to our breast reconstruction, reduction, and abdominoplasty patients. Responses were compared between surgery groups and demographic groups. Ordinal logistic regression analysis was used to determine the impact of patient characteristics on helpfulness rank of different sources. Results Survey results were obtained from 58 patients, of whom 10 (17.2%) had abdominoplasty, 35 (60.3%) breast reconstruction, and 13 (22.4%) breast reduction. The most popular information sources prior to the first surgical appointment were Internet searches (56.9%) and family/friends/other patients (39.7%). After the initial appointment, the most useful sources were plastic surgeons (84.5%), and the Internet (36.2%). Most patients (73.5%) still sought outside information after their appointment. On a Likert-type scale of helpfulness, plastic surgeons ranked 4.28/5, followed by the web-based patient education platform, 3.73 and the Internet, 3.6. A total of 63% of participants listed plastic surgeons as their single most important source of information. In ordinal logistic regression analysis, non-white race was significantly associated with higher rank of surgeon helpfulness (p < 0.05). Relative to low-income patients, income $50-100k (p < 0.05) and $100k+ (p < 0.05) were associated with lower rank of surgeon helpfulness. Conclusions Most patients seek outside information prior to visiting with a surgeon from the Internet, social media, or family and friends. Patients consider plastic surgeons their most valuable information source overall, though still in need of supplementation for varying reasons. Additionally, certain demographic differences affect patient perception of information sources, and this is an important factor for surgeons to consider as they approach educating patients.