A Low-Cost Simulator for Training in Endoscopic-Assisted Transaxillary Dual-Plane Breast Augmentation.

[BACKGROUND] Endoscopic-assisted transaxillary dual-plane (EATD) technique is a popular procedure for breast augmentation, especially for Chinese women. However, frustration is often expressed by plastic surgeons when first attempting EATD surgery. Simulation-based teaching is beneficial for EATD training, but it is expensive. This study presents a low-cost simulator to help plastic surgeons exercise psychomotor skills during EATD surgery.

[METHODS] The low-cost simulator was invented by Dr Jie Luan (the senior author) and made of some easily available materials including a mannequin, a T-shirt printed the bottom anatomical structure of the chest, the order of dissection, and the potential bleeding spot, and an elastic compression garment printed the upper anatomical structure and the cut-off position to sever the pectoralis major muscle. The first-year residents of plastic surgery assessed their improvement by completing a 5-item evaluation questionnaire at the beginning and at the end of the simulation.

[RESULTS] Fifty participants enrolled in this study. There was a significant difference (P < 0.05) before and after the training regarding candidate confidence, anatomical awareness, and endoscope control including the dexterity and hand-to-eye coordination.

[CONCLUSIONS] The low-cost and simple maintenance simulator may help plastic surgeons, especially those in developing countries, to improve gradually their EATD breast augmentation skills with no risks in a way. Further randomized controlled trials are needed to test its validity and reliability.