Rijkx Maud, Saelmans Alexander, Hommes Juliette, Brandts Lloyd, De Bruijn Daisy, Piatkowski Andrzej, Heuts Esther
From the Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, the Netherlands.
Ann Plast Surg. 2024 Oct 1;93(4):516-526. doi: 10.1097/SAP.0000000000004036. Epub 2024 Jul 15.
Total breast reconstruction with autologous fat transfer (AFT) is a relatively new breast reconstruction method. Although AFT was predominantly used to correct postsurgical defects, the surgical skills of a total breast reconstruction with AFT are different and can be facilitated for novices to accelerate their learning process. This study aims to assess the learning curve of plastic surgeons in total breast reconstruction with AFT in the Netherlands.
A mixed-methods study was performed based on the multicenter randomized clinical BREAST trial data. For the qualitative analysis, semistructured interviews were conducted. To test hypotheses derived from the qualitative data, retrospective data analysis was performed using multilevel linear regression analysis of the patients undergoing AFT as a total breast reconstruction method.
The interviews revealed that plastic surgeons need to perform the procedure several times to learn and experience the technical details of total breast reconstruction with AFT. Learning and improving this technique works best by scrubbing in with an expert. Before plastic surgeons learn the optimal volume of fat reinjection over time, they tend to inject too little fat and subsequently too much fat over multiple procedures. With more experience, the rigottomy technique becomes more important. Besides technical details, managing patient expectations before starting treatment is paramount. Multilevel linear regression revealed a significant decrease ( P < 0.001) in the number of surgical procedures and the total injected volume ( P = 0.002) to complete a total breast reconstruction with AFT.
This is the first study that explores the learning curve involved in using AFT as a total breast reconstruction method. The feeling of when fat transfer is sufficient, and how to release scars for a good result without causing seromas, is best learned by scrubbing in with experienced colleagues during several procedures, interchanged with starting one's own practice.
自体脂肪移植（AFT）全乳重建是一种相对较新的乳房重建方法。尽管AFT主要用于纠正术后缺陷，但AFT全乳重建的手术技巧有所不同，有助于新手加速学习过程。本研究旨在评估荷兰整形外科医生在AFT全乳重建中的学习曲线。
基于多中心随机临床BREAST试验数据进行了一项混合方法研究。进行了定性分析，采用半结构化访谈。为了检验从定性数据得出的假设，对接受AFT作为全乳重建方法的患者进行回顾性数据分析，采用多级线性回归分析。
访谈显示，整形外科医生需要多次进行该手术，以学习和体验AFT全乳重建的技术细节。通过与专家一起洗手消毒参与手术，学习和改进这项技术的效果最佳。在整形外科医生了解随着时间推移脂肪再注射的最佳量之前，他们往往在多次手术中注射过少的脂肪，随后又注射过多的脂肪。随着经验的增加，rigottomy技术变得更加重要。除了技术细节外，在开始治疗前管理患者的期望至关重要。多级线性回归显示，完成AFT全乳重建的手术次数和总注射量显著减少（P<0.001）（P = 0.002）。
这是第一项探索将AFT用作全乳重建方法所涉及的学习曲线的研究。何时脂肪移植足够，以及如何松解瘢痕以获得良好效果而不引起血清肿的感觉，最好通过在多次手术中与经验丰富的同事一起洗手消毒参与手术，并结合自己开始实践来学习。
