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Page 10 of 15 Ewing et al. Plast Aesthet Res 2024;11:22 https://dx.doi.org/10.20517/2347-9264.2024.11

FUTURE DIRECTIONS
Since its emergence from the core principles of general surgery, plastic and reconstructive surgery has
consistently advanced and revolutionized both medicine and surgery. Microsurgery and even
supermicrosurgery have evolved alongside medical and surgical technology, allowing practitioners and
researchers to explore new frontiers. With each advancement, we must consider the future implications and
how it will impact patients, healthcare, and the field. Here, the authors comment on potential future
directions.

Equally as important to mitigating the effects of radiation is preventing them. However, preventing the
adverse effects of radiation is not always feasible or possible, as radiotherapy cannot, and should not, be
deferred when its benefits outweigh the risks. Predictive models that could analyze patient factors could
serve as clinical decision support tools, enhancing multidisciplinary care, patient education, and shared
decision-making. Healthcare professionals could utilize these models to predict, to a reasonable degree, the
post-radiation course in any given patient. Understanding the potential risk factors and associated
complication profiles could enable more accurate surgical planning and management. This, in turn, could
enhance preparedness and overall outcomes. Radiation oncologists have stressed the need for radiation
estimation since the 1980s, so as to better evaluate the pros, cons, and cost-effectiveness of radiotherapy .
[96]
[96]
Palma et al. have described an algorithm for radiation complication prediction models in normal tissues .
Other studies have investigated the risks of specific complications, such as hypothyroidism after
[97]
supraclavicular radiation in breast cancer . In Germany, a team of researchers have described an algorithm
of predictive factors for radiotherapy complications in normal tissue with increasing age as a risk factor for
telangiectasia and fibrosis . Smoking was also associated with an increased risk of telangiectasia .
[98]
[99]
Personalized healthcare is becoming increasingly more common in modernized medicine. With an
emphasis on improved patient outcomes and experience, treatment and management algorithms that are
patient-centered and patient-specific are essential tools to achieve these outcomes. There exists a large body
of literature outlining individualized breast cancer risk assessment [99-101] . Other works attempt to create
individualized breast cancer risk prediction models with the use of machine learning and artificial
intelligence [102,103] . Less research, however, focuses on complication or morbidity prediction. One study
developed a protocol to investigate radiation-induced skin fibrosis resulting from breast cancer treatment,
in an effort to derive an algorithm for personalized risk estimation .
[104]

Adjuncts have also been employed to mitigate the effects of radiation. Intraoperatively, fat grafting,
decellularized fat matrices, and/or acellular dermal matrix (ADM) have shown promise in reducing the
negative effects of skin fibrosis. Adipose-derived stem cells have demonstrated a therapeutic effect in
radiated fields, with the ability to amplify wound healing and alter genetic expression, modifying hypoxia
and inflammation [105,106] . Prophylactic lipofilling has been shown to be beneficial in mitigating radiation
effects on tissue at both a qualitative and a quantitative level [107,108] . Potential uses of hyperbaric oxygen and
other pharmaceutical agents have also been utilized . ADM has shown promise in inhibiting capsular
[8]
[109]
contracture in post-mastectomy radiotherapy . These findings were corroborated in a large Spanish
multicenter analysis of 1,450 pre-pectoral breast reconstructions with ADM, reporting a low incidence of
capsular contracture (2.1%) . Postoperative wound care with hydrogel and hydrocolloid dressings have
[110]
also been used, citing the benefits of moist environments to prevent pain and accelerate wound
healing [111,112] .