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The practice of partial mastectomy (PM) in patients with breast cancer has gained momentum over total mastectomy since the results of randomized clinical trials that have provided evidence demonstrating equivalent survival. 1 But in recent years there has been a relative decline in PM compared to bilateral mastectomies, which has been attributed to inadequate esthetic outcomes after PM without reconstruction, which ultimately affects patient satisfaction and their health-related quality of life. 2 On the other hand, PM with immediate reconstruction -what we define as oncoplastic breast surgery (OPBS) -has been proven to be a safe and efficacious means of improving both aesthetics outcomes compared to PM alone without affecting oncological outcomes. 3 Despite the benefits of OPBS, its nationwide utilization has never been precisely quantified. To facilitate future efforts to increase its availability to appropriate candidate patients, this study aims to establish the recent rate and temporal trends of national utilization of OPBS.The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was reviewed for the period 2006-2015 to identify all women 18 years and older who were diagnosed with invasive breast cancer or carcinoma in situ, and underwent PM, as well as identify the subset of women who also underwent any reconstructive procedure during the 30-day postoperative period.The primary outcome was the overall rate of OPBS for the study period, and the temporal trends from 2006 to 2015. The secondary outcome was the annual trend for each OPBS technique: volume displacement (VD), breast reduction (BR), volume reduction (VR), prosthesis, and mastopexy. All statistical tests were two-sided, and p-value of < 0.05 was considered significant. A total 91,129 women underwent PM during the period 2006-2015 of which 4.2% ( n = 3777

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Background In many units around the world, microsurgical free-tissue transfer represents the gold standard for reconstruction of significant soft tissue defects following cancer, trauma or infection. However, many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources, infrastructure or training required to perform any microsurgical procedures. Long-term international collaborations have been formed with annual short-term reconstructive missions conducting microsurgery. In the first instance, these provide reconstructive surgery to those who need it. In the longer-term, they offer an opportunity for teaching and the development of sustainable local services. Methods A PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive, predetermined search strategy will be applied to the MEDLINE and Embase electronic databases from inception to August 2021. All clinical studies presenting sufficient data on free-tissue transfer performed on short-term collaborative surgical trips (STCSTs) in LMICs will be eligible for inclusion. The primary outcomes are rate of free flap failure, rate of emergency return to theatre for free flap salvage and successful salvage rate. The secondary outcomes include postoperative complications, cost effectiveness, impact on training, burden of disease, legacy and any functional or patient reported outcome measures. Screening of studies, data extraction and assessments of study quality and bias will be conducted by two authors. Individual study quality will be assessed according to the Oxford Evidence-based Medicine Scales of Evidence 2, and risk of bias using either the ‘Revised Cochrane risk of bias tool for randomized trials’ (Rob2), the ‘Risk of bias in non-randomized studies of interventions’ (ROBINS-I) tool, or the National Institute for Health Quality Assessment tool for Case Series. Overall strength of evidence will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Discussion To-date the outcomes of microsurgical procedures performed on STCSTs to LMICs are largely unknown. Improved education, funding and allocation of resources are needed to support surgeons in LMICs to perform free-tissue transfer. STCSTs provide a vehicle for sustainable collaboration and training. Disseminating microsurgical skills could improve the care received by patients living with reconstructive pathology in LMICs, but this is poorly established. This study sets out a robust protocol for a systematic review designed to critically analyse outcomes. Systematic review registration PROSPERO 225613