Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England

Abstract

Introduction. Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown. Methods. Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding. Results. We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease. Discussion. There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.

Current practice and provision of oncoplastic breast-conserving surgery in the UK: results of the ANTHEM national practice questionnaire

“…Reasons for this were multifactorial but concerns about complications and the perception that better symmetry would be achieved following completion of radiotherapy. These findings are consistent with the previous survey findings [ 14 ] and appears to be a common approach [ 15 ]. However, data to support this practice are lacking.…”

Oncoplastic Breast Surgery for Early Breast Cancer

“…In contrast, the most common pedicle used in Aggarwal et al (2016) cohort was superomedial (62%) followed by inferior pedicle (34%). In Adimulam et al (2014) 2010) as 88% of patients expressed no regret over having undergone breastconserving surgery and would not choose another kind of breast surgery even if they could choose again.…”

The TeaM ( T h e r a peutic M ammaplasty) study: Protocol for a prospective multi-centre cohort study to evaluate the practice and outcomes of therapeutic mammaplasty

“…Data regarding the numbers of TM procedures performed nationally are lacking. A national survey of specialist centres, however, suggests that between 10 and 20 TM procedures per centre per year may be a reasonable estimate of volume per centre [25]. It is anticipated that the majority of the 144 breast units in the UK will offer TM to their patients.…”