Impact of a Microsurgical Curriculum on Intraoperative Efficiency and Technical Skills in Free Flap Breast Reconstruction.

Microsurgery is an essential component of plastic surgery, yet its technical demands and steep learning curve pose challenges for trainees. The Fundamentals of Microsurgery (FMS) curriculum is a structured, competency-based simulation training program with five increasingly difficult noncadaveric tasks testing microsurgical dexterity outside the operating room (OR). This study evaluates the impact of FMS simulation on microsurgical efficiency and technical skills in plastic surgery trainees, translated into outcomes in the OR.A retrospective review of 28 total integrated and independent plastic surgery residents who participated in the FMS curriculum from 2019 to 2024 at a single-institution was conducted, analyzing 168 individual arterial anastomoses amongst 104 unique free flap breast reconstructions in the OR. Patient predictive variables, including body mass index (BMI) and prior radiation where analyzed. Outcomes included arterial anastomosis times, intraoperative technical imperfections, and total operative times. Statistical analyses were performed to assess independent predictors of surgical efficiency, with  < 0.05.Completion of the FMS curriculum was significantly associated with shorter intraoperative arterial anastomosis times (22.45 minutes vs. 33.65 minutes;  < 0.001) and fewer intraoperative technical imperfections, even in more difficult cases such as patients with higher BMI and those with prior radiation.The FMS curriculum enhances microsurgical technical skills and operative efficiency in plastic surgery trainees, even in difficult cases. These findings underline the necessity for standardized microsurgical training curricula to improve operative efficiency and technical precision. FMS or similar models should be integrated into all plastic surgery training programs to optimize patient outcomes and trainee competency.