How well are Brazilian mastologists (breast surgeons) trained in breast reconstruction and oncoplastic surgery? A study of the impact of a breast reconstruction and oncoplastic surgery improvement course

Abstract

IntroductionThe breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons’ technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients’ management by the surgeons enrolled in the Course, as well as to characterize their profile.MethodsAll students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded.ResultsTotal students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course.ConclusionThe Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists’ management of patients. New training centers worldwide can help a lot of women with breast cancer.

Training in oncoplastic surgery for mastologists

“…Applying the selection criteria, 16 articles were ultimately chosen for comprehensive examination, representing the primary focus of this article. These articles were categorized as follows: consensus 15 , hands-on OPS courses 16 , simulators 17 , 18 , 26 , porcine models 19 , or practical courses in humans/cadaver labs 20 , 21 , fellows in OPS 22 , 23 , 27 , 28 , medical residency 29 , 30 , learning curve 31 , and limitations and perspectives 32 .…”

“…Regarding the oncoplasty training centers for senior mastologists in Brazil, we identified a total of seven centers, two of which had published their results 20 , 21 . In the context of training senior mastologists ( Table 1 ), seven courses were conducted in Brazil.…”

“…Table 1 synthesizes information about the courses up to the present date. The model positively impacted clinical practice 20 , 21 . Among the continuous courses held in Brazil, the number of classes varied from 200 h to 540 h. Theoretical discussions were associated with clinical practice, in which multiple simultaneous surgical rooms, various types of surgery, and bilateral surgeries helped enhance surgical skills.…”

“…In 2009, the first international consensus on this subject was established 15 . There are reports of hands-on courses on OPS 16 , simulator models 17 , 18 , porcine models 19 , and cadaver labs 20 , 21 . For the new breast surgeon, fellowship programs in OPS were also established 22 , 23 .…”

“…This has complemented existing techniques and fostered the substantial development of oncoplasty and breast reconstruction 24 . The concept of OPS has been embraced by the Brazilian Society of Mastology, leading to the creation of training courses for senior mastologists 20 , 21 . These courses have taken various formats, including biennial, annual, or modular.…”