Teaching Microsurgical Breast Reconstruction-A Retrospective Cohort Study.

Sebastian Fischer,Christoph Hirche,Christian A Radu,Emre Gazyakan,Thomas Kremer,Dimitra Kotsougiani-Fischer,Yannick F Diehm,Ulrich Kneser

doi:10.3390/jcm10245875

Abstract

Microsurgical breast reconstruction demands the highest level of expertise in both reconstructive and aesthetic plastic surgery. Implementation of such a complex surgical procedure is generally associated with a learning curve defined by higher complication rates at the beginning. The aim of this study was to present an approach for teaching deep inferior epigastric artery perforator (DIEP) and transverse upper gracilis (TUG) flap breast reconstruction, which can diminish complications and provide satisfying outcomes from the beginning. DIEP and TUG flap procedures for breast reconstruction were either performed by a senior surgeon (>200 DIEP/TUG, ”no-training group”), or taught to one of five trainees (>80 breast surgeries; >50 free flaps) in a step-wise approach. The latter were either performed by the senior surgeon, and a trainee was assisting the surgery (“passive training”); by the trainee, and a senior surgeon was supervising (“active training”); or by the trainee without a senior surgeon (“after training”). Surgeries of each group were analyzed regarding OR-time, complications, and refinement procedures. A total of 95 DIEP and 93 TUG flaps were included into this study. Before the first DIEP/TUG flap without supervision, each trainee underwent a mean of 6.8 DIEP and 7.3 TUG training surgeries (p > 0.05). Outcome measures did not reveal any statistically significant differences (passive training/active training/after training/no-training: OR-time (min): DIEP: 331/351/338/304 (p > 0.05); TUG: 229/214/239/217 (p > 0.05); complications (n): DIEP: 6/13/16/11 (p > 0.05); TUG: 6/19/23/11 (p > 0.05); refinement procedures (n): DIEP:71/63/49/44 (p > 0.05); TUG: 65/41/36/56 (p > 0.05)), indicating safe and secure implementation of this step-wise training approach for microsurgical breast reconstruction in both aesthetic and reconstructive measures. Of note, despite being a perforator flap, DIEP flap required no more training than TUG flap, highlighting the importance of flap inset at the recipient site.

Highlights

The aim of this study was to present an approach for teaching deep inferior epigastric artery perforator (DIEP) and transverse upper gracilis (TUG) flap breast reconstruction, which can diminish early complications and provide secure and satisfying outcomes from the first breast reconstruction with DIEP or TMG flap, respectively
We performed 96 DIEP and 93 TUG flaps for unilateral microsurgical breast reconstruction
This study demonstrates that microsurgical breast reconstruction can be ta This study demonstrates that microsurgical breast reconstruction can be taught safely safely and securely by means of a stepwise training approach

Summary

Introduction

Compared to silicone implant-based reconstructions, autologous tissue obtains several advantages, of which the most important for oncologic patients is the significantly lower complication rate after irradiation therapy [11]. In this case, some authors even suggest autologous tissue transfer as reconstruction of choice, if donor sites are available [12,13]. Several studies already investigated the implementation process of microsurgical breast reconstruction and described a so-called learning curve [19,20,21]. An appropriate training concept would improve patient safety and outcomes

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