key: cord-0785010-fou1ssgc authors: Tejos, Rodrigo; Navia, Alfonso; Rojas, Maria Fernanda; Cuadra, Alvaro; Searle, Susana title: A Novel, Low-Cost Method for Teaching Breast Reduction Markings to Plastic Surgery Residents Amid the COVID-19 Pandemic date: 2021-02-04 journal: Aesthet Surg J DOI: 10.1093/asj/sjaa316 sha: 1b8c396cd729e7dd51fb4da35be649002c4905bd doc_id: 785010 cord_uid: fou1ssgc nan Editorial Decision date: October 2, 2020; online publish-ahead-of-print February 4, 2021. The COVID-19 pandemic has not only affected plastic surgery practice but also resident training. In our institution, firstyear resident intake occurs in June, which coincided with the peak of COVID-19 cases in Chile. To maintain aesthetic surgical training opportunities to some extent, we implemented different strategies while maintaining social distance and minimizing exposure. The process of marking patients prior to breast reduction is key to a satisfactory outcome, because it guides tissue resection patterns while protecting the blood supply to the nipple-areola complex. Efforts have been made to simplify breast reduction marking techniques 1 ; however, practice makes perfect. Simulation training offers consistent and reproducible ways to learn skills. The tasks trainers are essential components to the success of a simulation-based program. Several authors have described models for acquiring skills for both aesthetic 2,3 and reconstructive 4,5 breast surgery. However, some previously described breast surgery task trainers involve prohibitive cost for certain settings ($1500 USD) or they are custom-made, resulting in product variability and prolonged delivery time. To find an affordable alternative, we searched for available products that could be adapted for this utilization. We found that external silicone breast prostheses offer a cheap reproduction of breast anatomy, so we bought a model to test it. The cost for this model was $91 USD including shipping from China to Chile through an Alibaba supplier (CYOMI Crossdressing Store, Aliexpress.com, Hangzhou, China). Breasts were hypertrophic, slightly asymmetric, made of flexible and easy-to-clean silicone, with a soft and pliable feel. The inframammary folds were well defined, and the model even included printed anatomical landmarks such as the clavicles and sternal notch. We mounted the model on a mannequin to simulate a standing patient (Figures 1 and 2) , but it could be mounted on a human body as well, which may facilitate simulation of patient-doctor interaction. The model allows residents to practice breast marking for a variety of resection patterns. Inframammary folds, sternal notch to nipple distance, and breast meridian, among other measurements, can be easily taught. However, it is worth mentioning that these breasts are just mildly ptotic and particularly close together compared with an average patient. Residents provided good feedback regarding the experience, as allowed practicing in a safe environment, without the pressure of patient interaction in the midst of the pandemic. We are currently validating a breast reduction marking training program due to the success of this experience (Video). COVID-19 has forced us to seek new methods for postgraduate plastic surgery training. The role of simulation should not be overlooked while contact with patients has been considerably reduced during these times. We believe that external silicone breast prostheses are a promising alternative task trainer for plastic and breast surgery trainees, because they offer an affordable, readily available, reusable, and high-fidelity alternative. This article contains supplemental material located online at www.aestheticsurgeryjournal.com. Video. Watch now at http://academic.oup.com/asj/ article-lookup/doi/10.1093/asj/sjaa316 A step-by-step approach to a successful cosmetic breast reduction Mastotrainer: new training project for breast aesthetic and reconstructive surgery Mastotrainer new version: realistic simulator for training in breast surgery Validation of an oncoplastic breast simulator for assessment of technical skills in wide local excision Silicone-based composites as surgical breast models for oncoplasty training The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The authors received no financial support for the research, authorship, and publication of this article.