{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:01:52Z","timestamp":1786114912364,"version":"build-2736575974"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","funder":[{"name":"German Society of Plastic Reconstructive and Aesthetic surgeons"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Prospective national registry data provide a unique opportunity to evaluate whether increasing experience and structured certification translate into improved microsurgical breast reconstruction outcomes over time.<\/jats:p>\n                  <jats:p>All microsurgical free-flap breast reconstructions recorded in the prospective quality assessment database of the German Society of Plastic, Reconstructive, and Aesthetic Surgeons between 2011 and 2018 were analyzed. Data from 22 certified centers were included. Temporal trends in flap selection, operative parameters, and clinical outcomes were assessed at national, center, and surgeon levels.<\/jats:p>\n                  <jats:p>A total of 5,671 microsurgical flaps in 4,909 patients were evaluated. Overall flap-loss rates remained stable throughout the study period (2.6\u20134.2%, p\u2009=\u20090.894) despite increasing center participation and surgeon experience. Additional flap techniques were gradually introduced; however, diversification remained limited with heterogeneous uptake across centers, and deep inferior epigastric perforator (DIEP) remained the predominant reconstructive option. Operative duration decreased significantly in high-volume centers (mean difference: \u221238\u2009minutes, 95% CI: \u221269 to \u22127; p\u2009=\u20090.020) and among more experienced surgeons (mean difference: \u221230\u2009minutes, 95% CI: \u221249 to \u221211; p\u2009=\u20090.003), but no overall reduction in operative duration was observed over time. In contrast, ischemia time showed an overall trend toward prolongation.<\/jats:p>\n                  <jats:p>Microsurgical breast reconstruction within a nationwide network of certified centers achieved consistently high and internationally comparable outcomes. Despite increasing institutional experience and the introduction of additional flap techniques, flap-loss rates remained stable, and DIEP remained the predominant reconstructive option. Although learning-curve effects were identifiable at both the institutional and surgeon level, they did not translate into further reduction in complications. Further quality improvement is therefore more likely to benefit from structured benchmarking and regular feedback of operative and outcome metrics than from technical refinements alone.<\/jats:p>","DOI":"10.1055\/a-2920-4042","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:14:27Z","timestamp":1784762067000},"source":"Crossref","is-referenced-by-count":0,"title":["Have Outcomes Improved in Microsurgical Breast Reconstruction? An 8-Year Prospective Longitudinal Study of 5,671 Flaps Across 22 Centers"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3415-3051","authenticated-orcid":false,"given":"Uwe","family":"von Fritschen","sequence":"additional","affiliation":[{"name":"HELIOS Hospital Emil von Behring, Germany","place":["Berlin"],"department":["Department of Plastic and Esthetic Surgery, Hand Surgery"]},{"name":"University of Regensburg, Germany","place":["Regensburg"],"department":["Faculty of Medicine, Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Fertsch","sequence":"additional","affiliation":[{"name":"Interdisciplinary Breast Center, Sana Kliniken D\u00fcsseldorf GmbH, Germany","place":["D\u00fcsseldorf"],"department":["Department of Plastic and Aesthetic Surgery"]},{"name":"University Witten Herdecke, Germany","place":["Witten"],"department":["Faculty of Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Arkudas","sequence":"additional","affiliation":[{"name":"University of Erlangen, Bayern, Germany","place":["Erlangen"],"department":["Department of Plastic and Hand Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maike","family":"Keck","sequence":"additional","affiliation":[{"name":"Agaplesion Diakonieklinikum Hamburg, Germany","place":["Hamburg"],"department":["Department of Plastic, Reconstructive and Aesthetic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2826-2793","authenticated-orcid":false,"given":"Emre","family":"Gazyakan","sequence":"additional","affiliation":[{"name":"University of Heidelberg, Germany","place":["Ludwigshafen"],"department":["Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schiltz","sequence":"additional","affiliation":[{"name":"HELIOS Hospital Emil von Behring, Germany","place":["Berlin"],"department":["Department of Plastic and Esthetic Surgery, Hand Surgery"]},{"name":"University of Regensburg, Germany","place":["Regensburg"],"department":["Faculty of Medicine, Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"issue":"02","key":"ref1","first-page":"58","article-title":"[Quality assurance in breast reconstruction - establishment of a prospective national online registry for microsurgical breast reconstructions]","volume":"52","author":"U V Fritschen","year":"2020","journal-title":"Handchir Mikrochir Plast Chir"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3390\/jcm10051016","article-title":"Overall complication rates of DIEP flap breast reconstructions in Germany-a multi-center analysis based on the DGPR\u00c4C prospective national online registry for microsurgical breast reconstructions","volume":"10","author":"P I Heidekrueger","year":"2021","journal-title":"J Clin Med"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1097\/SAP.0000000000002628","article-title":"Effect of radiation therapy on microsurgical deep inferior epigastric perforator flap breast reconstructions: a matched cohort analysis of 4577 cases","volume":"86","author":"L Prantl","year":"2021","journal-title":"Ann Plast Surg"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1016\/j.bjps.2020.12.043","article-title":"Impact of body mass index on free DIEP flap breast reconstruction: a multicenter cohort 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Kamali","year":"2017","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/PRS.0000000000008706","article-title":"National Trends in length of stay for microvascular breast reconstruction: an evaluation of 10,465 cases using the American College of Surgeons National Surgical Quality Improvement Program database","volume":"149","author":"K A Holoyda","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"101605","DOI":"10.1016\/j.suronc.2021.101605","article-title":"Uni-vs. bilateral DIEP flap reconstruction - a multicenter outcome analysis","volume":"38","author":"N Moellhoff","year":"2021","journal-title":"Surg Oncol"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1055\/a-2817-4800","article-title":"Impact of a microsurgical curriculum on intraoperative efficiency and technical skills in free flap breast reconstruction","author":"P 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Bodin","year":"2015","journal-title":"Ann Chir Plast Esthet"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1177\/14574969241312286","article-title":"Reduced length of stay and less systemic complications, implementation of the optimized DIEP recovery pathway","volume":"114","author":"I Korpiola","year":"2025","journal-title":"Scand J Surg"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"162e","DOI":"10.1097\/PRS.0000000000011951","article-title":"Moving toward the outpatient DIEP flap: factors influencing early discharge","volume":"156","author":"F D Graziano","year":"2025","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref28","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1055\/a-2460-4821","article-title":"Unplanned 180-day readmissions and health care utilization after immediate breast reconstruction for breast cancer","volume":"41","author":"A J Rios-Diaz","year":"2025","journal-title":"J 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