Abstract As patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction frequently anticipate improved abdominal contour, they may also expect a degree of meaningful weight loss. This study aims to clarify whether patients undergoing mastectomy with DIEP flap breast reconstruction experience a significant and durable change in body mass index (BMI). A single-institution, retrospective cohort study was performed on patients who underwent DIEP flap breast reconstruction between 2020 and 2021. Patients were included if they had BMI data available from ≤ 3 months before mastectomy until ≥ 2 years after reconstruction. Every BMI data point within this timeframe was captured. Longitudinal BMI trends were analyzed using a mixed-effects model for the overall cohort and for subgroups of patients with immediate or delayed breast reconstruction. A total of 143 patients (median age at reconstruction, 51.6 years) were included. Most patients (55.5%) underwent unilateral mastectomy and reconstruction. The mean mastectomy tissue masses were 640.8 g (SD 260.9) and 1,363.5 g (SD 713.9) for unilateral and bilateral cases, respectively. In the overall cohort and delayed reconstruction subgroup, there were no significant changes in BMI between pre-mastectomy and post-reconstruction periods. In contrast, patients with immediate reconstruction experienced a BMI decrease of 0.445 kg/m2 between pre-procedure and post-procedure periods (p = 0.023), corresponding to a weight loss of 2.70 lbs. In a cohort of 143 patients, we did not find evidence of clinically significant BMI change associated with mastectomy and DIEP flap breast reconstruction. These results may improve the comprehensiveness and clarity of perioperative counseling, ensuring patients formulate evidence-based reconstructive preferences.
Abstract Microsurgery is a critical component of plastic and reconstructive surgery. However, the high cost of training and equipment poses significant barriers, particularly in resource-limited settings. To address this challenge, the Microsurgery and Regenerative Medicine Laboratory within the Division of Plastic Surgery at the University of Wisconsin developed a low-cost, three-dimensionally (3D)-printed surgical microscope. This study qualitatively appraised the use of this novel microscope for microsurgery training by surveying surgeons about their experiences using this tool relative to traditional magnification methods. In this prospective, multi-institutional appraisal study, surgical residents, fellows, and attending surgeons with varying microsurgical experience performed a single end-to-end microsurgical anastomosis on chicken thigh femoral arteries using the 3D-printed microscope. Participants then completed a survey assessing ease of use, adequacy for microsurgical training, educational value, and perceived impact on teaching capacity in local and global settings. Over 80% of participants (Survey 1: n = 36; Survey 2: n = 24) reported that performing an end-to-end anastomosis was easier or equivalent using the 3D-printed microscope compared with surgical loupes. All respondents expressed willingness to use the device for microsurgery teaching and practice. Additionally, 91.7% (33/36) believed access to the microscope would enhance microsurgical teaching at their home institutions, and 97.1% (34/35) felt it would improve teaching capacity globally. Qualitative feedback was overwhelmingly positive, with suggestions primarily related to ergonomics and lighting. This study supports that this low-cost, 3D-printed microscope is an effective microsurgical training tool. Ongoing design refinements informed by user feedback may further optimize its role in expanding access to microsurgery education worldwide.
Background Robotic-assisted microsurgery offers enhanced precision, tremor filtration, and improved ergonomics, but adoption is limited by undefined learning curves. This systematic review evaluates the learning curve of microvascular anastomosis performed on dedicated robotic platforms. Methods A systematic review was conducted across MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception to June 2025). Evaluated outcomes included time metrics (anastomosis time, time per stitch), microsurgical skills and anastomosis quality for the robot-assisted (RA) and hand-sewn (HS) techniques. Results After screening 6,743 records, 19 studies were included. In preclinical studies (n=11), mean RA anastomosis time decreased by 18.54 [4.01–47.00] minutes versus 8.43 [0.31–30.00] minutes for HS, although mean final RA time remained longer at the final attempt (20.94 [8.99–36.00] vs 14.78 [4.58–30.00]). RA time per stitch decreased by a mean of 2.96 [0.83–5.62] minutes compared to 1.58 [-0.31–4.84] minutes in the HS group. Preclinical microsurgical skill scores improved by 0.99 [0.50–1.63] in the RA group and by 0.76 [-0.10–1.30] in the HS group. In clinical studies (n=8), RA anastomosis time was reduced by 18.03 [6.30–37.27] minutes over anastomosis attempts. Preclinical Anastomosis Lapse Index scores were comparable between techniques. Reported immediate patency in clinical settings ranged from 95.66% to 100%. Conclusion Performance on dedicated robotic platforms improved with practice, but the current evidence did not demonstrate overall superiority over HS technique. In preclinical studies, final RA anastomosis and per-stitch times remained longer, while early anastomosis quality and patency were broadly comparable. Considering added time and platform-associated costs, the clinical settings in which robotic assistance may provide a meaningful benefit remain to be defined. Heterogeneity in models, operators, platforms, and outcome reporting limits definitive characterization of the learning curve. Future studies should standardize learning curve methodology, report complete sequential trajectories, and define clinically relevant proficiency thresholds before integration into credentialing frameworks.
Abstract Comprehensive lymphedema programs (CLPs) have recently been established at several large academic medical centers. However, little has been published regarding implementation of multidisciplinary lymphedema programs serving predominantly rural and medically underserved populations. We describe our early experience developing a CLP and highlight lessons that may facilitate implementation in similar settings. We performed a retrospective review of all patients referred to our CLP from November 2021 to April 2024. Patients without complete electronic medical record information were excluded. Financial analyses were limited to patients who underwent operative intervention and completed all insurance preauthorization and appeal processes. A total of 321 patients were referred to our CLP, of whom 190 underwent complete evaluation. Seventy-three patients (38.4%) underwent operative intervention, including 43 (58.9%) who underwent immediate lymphatic reconstruction (ILR). Among patients undergoing delayed lymphatic reconstruction (DLR), 60% underwent physiologic and 26.7% underwent debulking procedures. The program demonstrated sustained growth throughout the study period with expansion into a multistate referral network. Insurance reimbursement remained limited, with insurers covering 29.7% of surgeon fees and total reimbursement averaging 35.7% of billed surgeon charges. Development of a CLP serving a predominantly rural and medically underserved population region is feasible through multidisciplinary collaboration, strategic resource allocation, and adaptation to local resources. The principles described may provide a practical framework for developing sustainable CLPs and expanding access to specialized lymphedema care in similar settings.
Background: Patient proximity to a surgical center is an important consideration of coordination and delivery of high-quality postoperative care. Implant-based and autologous breast reconstruction require different perioperative resources and may be impacted in a varying manner by distance from the health care center. This study evaluated the impact of geographic distance on clinical and financial outcomes in free flap and implant-based breast reconstruction. Methods: A retrospective review was conducted of 176 free flap and 239 implant-based immediate breast reconstructions performed from 2017–2023 at a single academic center. Patients were classified by great-circle distance to the medical center as far (≥30 miles) or near (<30 miles). Propensity score–matched cohorts were created for free flap (n=70 pairs) and implant-based (n=79 pairs) reconstruction, controlling for demographics, comorbidities, treatment variables and laterality. Clinical outcomes, wound complications, revision procedures, opioid use, hospital resource utilization, and financial measures between near and far patients for each reconstruction type were compared using paired t-tests, McNemar’s tests, and exact binomial testing for sparse outcomes. Results: In the flap cohort, near- and far-distance groups did not differ significantly in operative time, length of stay, intensive care use, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes. Total flap loss and thromboembolic events were rare and did not differ significantly between groups. In the implant-based cohort, there were no significant differences in operative time, length of stay, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes between groups. Conclusion: Geographic distance was not associated with worse clinical or financial outcomes after immediate breast reconstruction. These findings suggest that high-volume academic centers can deliver consistent reconstructive outcomes across a range of patient proximities.
