Impact of Resident and Physician Assistant Participation on Cosmetic Plastic Surgery Outcomes in an Appalachia...

The integration of residents and physician assistants (PAs) into cosmetic plastic surgery has become increasingly common to address workforce shortages and maintain educational opportunities. However, questions remain about their impact on operative efficiency and outcomes.

A retrospective review was conducted of 78 cosmetic surgery cases performed at an academic medical center between October 2022 and October 2024. Cases included abdominoplasty, breast augmentation/mastopexy, abdominoplasty combined with breast augmentation/mastopexy, breast augmentation mammaplasty, and reduction mammaplasty. Patients were stratified by team composition: attending surgeon alone, attending surgeon with a resident, attending surgeon with a PA, and attending surgeon with both a resident and a PA. Operative time, estimated blood loss (EBL), and complications were compared using analysis of variance and descriptive statistics.

No significant differences in overall operative time or EBL were observed across team compositions (P > 0.05). However, when analyzed by procedure type, significant findings emerged. In abdominoplasty combined with breast augmentation/mastopexy, solo cases had significantly longer operative times compared with assisted groups (P = 0.017). In breast augmentation mammaplasty, resident participation was associated with the lowest mean EBL (P = 0.026). Only 2 complications occurred in the entire cohort (2.6%), with no difference across groups.

Resident and PA participation in cosmetic plastic surgery does not compromise patient safety or outcomes. These findings support the inclusion of residents and PAs in aesthetic procedures as both feasible and beneficial, balancing education with high-quality patient care.