AB153. SOH24AB_253. Microsurgical breast reconstruction training: are trainee’s up for the challenge?

Background: Microsurgical free flap reconstruction is a complex, multi-step process requiring a steep learning curve, advanced psychomotor capabilities, and repetitive practices over a time period. Consequently, microsurgical breast reconstruction is traditionally a consultant delivered service to minimise risk of adverse outcomes and optimisation of theatre efficiency. The aim of this study is to compare consultant versus trainee flap raising and microvascular anastomosis in deep inferior epigastric perforator (DIEP) free flap breast reconstruction.

Methods: We performed a retrospective review of patients undergoing DIEP free flap breast reconstruction for treatment of breast cancer between July 2020 and July 2021 in a single-centre two consultant surgeon university hospital practice. Factors assessed were percentage trainee v consultant involvement in flap raise and microanastomoses, overall flap ischaemic time, procedure duration and adverse outcomes.

Results: A total of 73 DIEP flaps were performed. There were no cases of flap loss. 10% had post-operative complications grade I to III according to Clavien-Dindo classification, with no difference between consultant versus trainee lead cases (P=0.871). Trainees were involved (either raising flap, microanastomosis of artery or vein) in 35% of cases (n=26 flaps). There was a statistical significant in ischaemic time when trainee perform the microanastomoses (P<0.001), however, there was no statistical significant in total operative time (P=0.561).

Conclusions: Despite longer time to completion of microsurgery anastomoses, the lack of statistical difference in post-operative complication and total operative time reaffirms the safety of trainee lead cases with continuous support from consultant trainers.

Keywords: Microsurgery; breast reconstruction; training; plastic surgery; training