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In this episode of How I Operate, Ryan Sugrue is joined by Adam Reid, Editor-in-Chief of JPRAS, to explore what really happens to plastic surgery research between submission and publication.

Following a manuscript through the editorial process, Adam explains what editors look for when assessing a paper, how peer review works, and why good methodology, research integrity and clinical relevance matter more than impressive conclusions. They also explore the growing influence of artificial intelligence on scientific publishing, the risks of inappropriate AI use, and what the next generation of plastic surgeons should consider when getting started in research.

Key Takeaways

• What happens to a manuscript after it is submitted to a plastic surgery journal.
• What editors look for in a title, abstract and methodology when first assessing a paper.
• Why following submission guidelines can make a difference before scientific review even begins.
• How peer reviewers are selected and how conflicting reviewer feedback is managed.
• Why limitations and negative findings should be reported honestly rather than hidden or overstated.
• How conflicts of interest and research integrity influence editorial decisions.
• The opportunities and risks associated with using AI in scientific research and publishing.
• Why strong methodology and clinically meaningful questions remain fundamental to good research.
• How mentorship, collaboration and building the right team can help surgeons get started in research.

Chapters:

00:15 – How Plastic Surgery Research Has Changed
04:48 – From Print Journals to Social Media
11:08 – What Happens After You Hit Submit?
15:53 – How an Editor Screens a Paper
18:57 – Building the Peer Review Team
26:14 – How Peer Review Really Works
31:23 – What Happens After Publication?
34:24 – Reviewing a Research Paper in Real Time
49:20 – AI and the Future of Scientific Publishing
01:01:21 – How to Get Started in Plastic Surgery Research

Thank you for listening to How I Operate.

If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released monthly, featuring the surgeons, innovators and ideas that continue to shape modern plastic surgery.

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In this episode of How I Operate, Ryan Sugrue is joined by Pedro Cavadas, a reconstructive microsurgeon known for tackling complex limb salvage and replantation cases where conventional reconstructive options can begin to run out.

Beginning with the medial sural artery perforator (MSAP) flap, Cavadas gives a characteristically direct account of where the flap is useful, where it is not, and why anatomy and surgical efficiency matter more than novelty. The conversation then moves into the practical details of microsurgery: intramuscular dissection, perforator selection, venous anastomosis, vessel geometry and the sequence of repair in digital replantation. Along the way, he challenges established dogma, explains the small technical habits he believes improve patency, and shares why de-airing an arterial anastomosis may be critical to avoiding unexplained flap failure.

Key Takeaways

• When the MSAP flap is a useful regional free flap and why Cavadas does not consider it a universal workhorse.
• How high-setting, non-stick bipolar dissection can make intramuscular perforator dissection faster and more controlled.
• Why Cavadas usually wants a single perforator and believes one perfect venous anastomosis can be better than two suboptimal ones.
• The microsurgical habits he uses to protect the endothelium, optimise vessel geometry, and improve anastomotic reliability.
• How changing the sequence of repair can make digital replantation faster, cleaner, and more reproducible under tourniquet.
• Why air bubbles in an arterial anastomosis may contribute to apparent “no-reflow” and unexplained flap failure.

Chapters

00:00 – Reconstructing the “Impossible”
01:50 – The Rise of Perforator Flaps and the MSAP Flap
04:15 – What the MSAP Flap Is Really Good For
08:40 – Choosing the Right Flap for Complex Limb Reconstruction
10:20 – Raising the MSAP Flap and Intramuscular Dissection
16:30 – Flap Design, Doppler and Perforator Selection
18:20 – Why One Vein Can Be Better Than Two
21:10 – Anastomosis Tricks and Avoiding Endothelial Injury
28:20 – Replantation Strategy, Bone Shortening and Repair Sequence
39:40 – Air Embolism, “No-Reflow” and Flap Failure

Thank you for listening to How I Operate. Brought to you by ThePlasticsFella.

If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released bi-weekly, featuring the surgeons, innovators, and ideas that continue to shape modern plastic surgery.

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In this episode of How I Operate, Ryan Sugrue is joined by Dr Elizabeth Hall-Findlay, whose work has helped reshape the way plastic surgeons think about breast reduction.

Dr Hall-Findlay traces the evolution of her approach from the traditional inverted T inferior pedicle technique to vertical reduction and the true superomedial pedicle. She explores the importance of separating skin design, blood supply and parenchymal reshaping, explaining why the skin shouldn't be relied upon as a "brassiere". From nipple position and pedicle selection to markings, tissue resection and managing complications, she shares the lessons and surgical principles developed throughout her career.

Key Takeaways:

• How Dr Hall-Findlay transitioned from the inverted T technique to vertical breast reduction.
• Why understanding the superficial blood supply is fundamental to pedicle design and nipple viability.
• The principles behind the true superomedial pedicle and its advantages for blood supply, sensation and breast shape.
• Why surgeons should "remove the excess where it is" rather than relying solely on predetermined patterns.
• How parenchymal reshaping, rather than skin tension, can create more predictable long-term results.
• The importance of the upper breast border, breast meridian and individual anatomy when determining nipple position.
• When a horizontal scar may still be required and why the vertical incision shouldn't be cinched.
• How honest reflection, photography and long-term follow-up can help surgeons continually refine their technique.

Chapters:

00:15 – The Evolution of Breast Reduction
03:24 – Moving Away from the Inverted T
06:29 – Transitioning to Vertical Reduction
09:49 – Understanding the True Superomedial Pedicle
14:33 – Sensation, Shape and Parenchymal Reshaping
24:52 – Remove the Excess Where It Is
31:03 – Gravity, Weight and the Inframammary Fold
36:47 – Marking the Breast and Choosing Nipple Position
47:00 – Inside the Hall-Findlay Technique
53:56 – The Pucker, the T and Surgical Judgement
58:59 – Managing Complications and Nipple Necrosis
62:26 – A Career Built on Surgical Evolution

Thank you for listening to How I Operate.

If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released monthly, featuring the surgeons, innovators and ideas that continue to shape modern plastic surgery.