Development and Pilot Evaluation of an e-Learning Module for Autologous Fat Transfer (AFT) in Total Breast Reconstruction in the Dutch Healthcare System: Insights From 9 Plastic Surgeons

Abstract

Introduction: Autologous Fat Transfer (AFT) for total breast reconstruction is a novel, minimally invasive technique recently introduced into the Dutch healthcare system. Although plastic surgeons are experienced with AFT for aesthetic and partial reconstructive procedures, its application for total breast reconstruction presents unique challenges, necessitating standardized training.

Methods: A multidisciplinary team developed an e-learning module on The Huddle platform, guided by adult learning theory, context-specific instruction, visual learning aids, and key insights from a clinical research program (BREAST trial). The module included text, videos, illustrations, and case-based learning. Nine Dutch plastic surgeons with varying experience levels pilot-tested the module. Semi-structured interviews assessed clarity, relevance, and usability.

Results: Feedback was predominantly positive. Participants appreciated the structured format, permanent accessibility, and visual materials that supported procedural understanding. Several surgeons reported intended changes to their surgical approach, such as modifications in fat harvesting. Suggested improvements included patient selection criteria, radiological aspects, and information on common complications. The absence of narrated videos was perceived as a limitation.

Discussion: The pilot demonstrated that a flexible, visually rich e-learning format can support knowledge acquisition in a novel surgical technique. Interdisciplinary collaboration and iterative feedback were key strengths. Limitations include the small sample size and the purely qualitative design, which restrict generalizability.

Conclusion: We developed and pilot-tested an e-learning module for AFT in total breast reconstruction. The module was well received and considered clinically relevant, and could hereby fill an (inter)national gap in standardised training. Future research should evaluate learning outcomes quantitatively, compare efficacy to traditional training, and assess long-term impact on surgical practice.

Keywords: AFT; Dutch healthcare system; autologous fat transfer; e-learning module; plastic surgery education; total breast reconstruction.

Figure 1

Left side, after amputation of left breast. Right side, after AFT-reconstruction of left breast, nipple reconstruction and reduction mammoplasty of right breast. Illustration: © Ava Krueger.

Figure 2

This figure provides an example of one of the modules, the use of the External Vacuum Expander (EVE-bra^®) on the chest, as preparation before the surgery. Illustration: © Ava Krueger.