Purpose: All graduating residents face the question of what techniques they will continue using in their own practice. As Plastic Surgery residents, this decision might become paramount in the choice to pursue fellowship training or in the form of an ongoing assessment over the first few years in practice. To answer the question whether to perform autogenous breast reconstruction as learned in residency or pursue fellowship training in the newest microsurgical techniques, a review of the outcomes at our institution was performed.

Materials and Methods: Breast cancer patients receiving 168 pedicled TRAM flap reconstructions were reviewed. A literature review using Medline keywords TRAM and DIEP was performed.

Results: Complications including partial flap loss (10.1%), complete flap loss (1.2%), and hernia formation (2.4%) were comparable to published rates of TRAM and DIEP flaps.

Conclusions: Graduating Plastic Surgery residents need to critically evaluate their surgical experience to make important choices about their future practice. The decision algorithm should balance operative experience with a thorough knowledge of institutional outcomes and a critical understanding of the current literature. Young Plastic Surgeons need to perform safe and effective procedures as they become established before becoming the innovators of tomorrow.