Background: Breast surgery is a diverse field of surgery involving both the domains of general surgery and plastic surgery to safely and effectively carry out complex procedures. It plays a critical role in the surgical management of breasts, improving patients’ health, psychological well-being, and body image. It has traditionally followed a largely observational apprenticeship model. However, due to increasing patient safety concerns, the advent of coronavirus disease 2019 (COVID-19), and many other limitations, there is an increased need for alternative training methods.
Methods: A systematic review was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key studies related to breast surgery simulators were searched on databases such as Medline and PubMed using search keywords. Studies were screened, analysed, and reviewed using inclusion and exclusion criteria. Relevant studies were included in our review. Data such as study demographics, study design, simulator characteristics, assessment evaluation, and cost were extracted using Microsoft Excel.
Results: Initially, 1,612 studies were identified, and only 34 studies were eligible for inclusion. Nineteen (57%) studies were from 2025 to 2020, while 15 (44.1%) were published from 2019 to 2015. Twenty-five (73.5%) simulators were deemed as high-fidelity, while 9 (26.5%) models were low-fidelity. The most common simulator material was silicon (29.4%) and porcine (29.4%), followed by 3 (8.8%) virtual simulators. The most common procedures assessed were free flaps (29.4%), mammoplasty (20.6%), and core needle biopsy (14.7%). Fourteen (41.2%) studies primarily focused on technical skills, while clinical judgement, mainly confidence, was assessed ten times (29.4%) in conjunction with other skills. In terms of validity, 47% of the studies examined the content and response of the task trainers. Nine studies (26.5%) used objective measures such as Objective Structured Assessment of Technical Skills (OSATS), Global Rating Scale (GRS), and Competency Assessment Tool (CAT) for performance assessment, while 5 (14.7%) used questionnaires. Only 8 studies (23.5%) assessed the reliability of their simulators.
Conclusions: Our study demonstrates that most research regarding simulators is about development, and research regarding utility and validation is largely lacking. However, where it is present, our research demonstrates that simulation training can aid in skill acquisition.
