Starting an autologous breast reconstruction program after plastic surgical training. Is it as good as it gets?

Background: Today, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard in microvascular breast reconstruction. Although this procedure is known as technically demanding, novice plastic surgeons must be able to perform these procedures to meet the rising demand. The purpose of this study was to evaluate if the young junior professional is trained adequately to set up and safely perform microsurgical breast reconstructions.

Methods: We compared outcomes of three identically trained novice plastic surgeons who introduced the DIEP flap in their working environment. Their hospitals differed in size and experience in microsurgery. Outcomes were compared between all start-ups and a center of excellence (EMC).

Results: A total of 152 DIEP flaps were performed in 123 patients among all start-ups together. Baseline characteristics and major complications were comparable between all groups. The total flap loss rate was 2% in the start-ups versus 3.9% in the control group (p = 0.5). Although there seems to be a trend in a longer operating time in both training and nontraining academic centers, no statistical significance was found between start-ups (p = 0.13) and the control group (p = 0.17). However, a learning curve seems to be present when it comes to duration of surgery and is greatest in the community centers with zero experience in microsurgery (ZGT p = 0.002, Amphia p = 0.065). The same accounts for hospital stay.

Conclusion: Although there seems to be a learning curve in terms of duration of surgery in hospitals with no experience in microsurgery, it is safe to perform microvascular breast reconstructions as a novice plastic surgeon.