94. Surgeon Experience and Outcomes in Microsurgical Breast Reconstruction: A 10-year Single Surgeon Analysis

PURPOSE: Microsurgery has become increasingly popular for breast reconstruction, with the DIEP (Deep Inferior Epigastric Perforator) flap being one of the most utilized methods. Achieving desirable outcomes from this technically demanding operation relies on a plastic surgeon’s expertise. While surgeons receive rigorous training throughout their residency and fellowship programs, plastic surgeons are believed to continue refining and improving their performance in independent practice. This study evaluates the effect of surgeon experience on clinical outcomes in microsurgical DIEP flap breast reconstruction. METHODS: Institutional IRB approval was obtained prior to the initiation of this study. A review of consecutive DIEP flaps performed by a single surgeon from 2013 to 2023 was performed. Comprehensive data was collected, including patient demographics, medical history, operative details, and postoperative complications. Patients were divided into “early” and “late” groups based on the midpoint date (July 21st, 2018) between the earliest and latest surgeries. Statistical analyses were conducted using Student’s t-tests, chi-squared analysis with Fisher’s exact test, and multivariable regressions controlling for comorbidities. RESULTS: The study included a total of 628 patients, with 242 in the early group and 386 in the late group. The early group had a higher mean age (52.31 vs. 50.48 years, p=0.027) and BMI (29.94 vs. 28.84, p=0.016). Additionally, the early group exhibited a higher percentage of patients with hypertension (35.1% vs. 26.7%) but a lower percentage with diabetes (14.0% vs. 8.0%). After controlling for potential confounders, the late group was significantly associated with fewer revision surgeries (IRR=0.677, CI=[0.54 0.85], p=0.0007) and a shorter length of stay (IRR=0.615, CI=[0.56 0.68], p<0.0001). CONCLUSION: This study demonstrates that even with extensive training, plastic surgeons continue to improve their practice and surgical outcomes through accumulated experience. These findings highlight the learning curve and volume-outcome relationship within plastic surgery, and specifically, microsurgical breast reconstruction. Moreover, they underscore the importance of ongoing practice to achieve optimal results in complex procedures like DIEP breast reconstruction. Therefore, patients may consider the experience level of their plastic surgeon a critical factor when making their choice of surgeon.