D74. No Compromise in Care: Plastic Surgery Resident Involvement on DIEP Flap Outcomes In a High-Volume Microsurgical Breast Practice

PURPOSE: To evaluate the impact of plastic surgery resident involvement on postoperative outcomes in DIEP flap breast reconstruction, addressing the gap in research on resident participation in complex microsurgery. METHODS: A retrospective review was conducted on 395 patients who underwent DIEP flap reconstruction from December 2021 to May 2024. Patients were stratified into three cohorts: dual attending surgeons without a resident (n = 174), with a plastic surgery resident (n = 147), or with a general surgery resident (n = 38). Demographics, operative details, and postoperative outcomes were analyzed, focusing on complication rates, flap ischemia time, infection, length of stay, and revisions. RESULTS: Demographics, comorbidities, and treatment histories were similar across all cohorts. Flap ischemia time was marginally longer in the plastic surgery resident cohort (46 minutes vs. 39 minutes, p = 0.001), but the difference was not clinically significant. No increase was observed in overall complications, including flap loss, reoperation, hematoma, seroma, or infection. Length of stay was comparable across all groups. CONCLUSION: The involvement of plastic surgery residents did not negatively impact any patient related outcomes. Flap ischemia time was statistically, though not clinically, increased, with no statistically significant increase in total operative time. This research holds broad implications for surgical education, supporting the notion that resident involvement in complex surgeries is both safe and vital for developing the next generation of skilled surgeons.