Oncoplastic Breast-Conserving Surgery in Low- and Middle-Income Countries: Training Surgeons and Bridging the Gap

Freitas‐Junior, Ruffo; Ferreira-Filho, Darley Lima; Soares, Leonardo Ribeiro; Paulinelli, Régis Resende

doi:10.1007/s12609-019-00317-3

Cited by 7 publications

(8 citation statements)

References 41 publications

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“…8 In developing countries, OPS uptake has been slow for a multitude of reasons, including economic factors, a paucity of surgeons trained in these techniques, and low levels of patient awareness. Despite these challenges, recent studies have demonstrated a safe and efficacious use of OPS in low-and middleincome countries, demonstrating a true global trend in the surgical management of breast cancer., 9,10…”

Section: History Of Opsmentioning

confidence: 99%

Oncoplastic surgery for breast cancer: Global perspectives and trends

Armstrong,

Maxwell

2023

Journal of Surgical Oncology

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Oncoplastic surgery (OPS) is a form of breast conservation that combines definitive oncologic resection with optimal aesthetic outcomes. Various definitions exist, with most focusing on volume displacement techniques to close the lumpectomy defect and redistribute the remaining breast volume over the preserved breast. Although its oncologic safety has been well demonstrated, uptake into practice varies globally. This article details the definition, safety, training opportunities, and practice patterns of OPS on a global scale.

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Section: History Of Opsmentioning

confidence: 99%

Oncoplastic surgery for breast cancer: Global perspectives and trends

Armstrong,

Maxwell

2023

Journal of Surgical Oncology

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“…They impact on self-image, self-esteem, and the relationship between women with themselves and the world. For these reasons, breast conservative surgery (BCS) is preferred by patients ( 1 , 2 ).. It is estimated that up to 30% of women who undergo BCS will have some residual deformity, many times difficult to correct ( 3 )..…”

Section: Introductionmentioning

confidence: 99%

“…However, this is not a reality in Brazil. Less than a third of SUS´s (Sistema Único de Saúde - Brazil´s public health system) users have access to immediate reconstructive surgery ( 1 , 16 ) even though they have the lawful right of having so ( 1 ). This low rate of breast reconstructions has multiple causes.…”

Section: Introductionmentioning

confidence: 99%

“…This low rate of breast reconstructions has multiple causes. Brazil´s population has important socioeconomic, ethnic and cultural diversity, and the deficiency in availability and surgeons’ technical qualification ( 1 , 16 ), which makes quality care a challenge ( 17 ). A greater number of surgeons trained to perform breast reconstructions and breast repairs tend to increase the percentages of these types of surgeries.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2023

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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.

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“…The disparity from western world stretches beyond economic factors and owe to limited number of surgeons adequately trained to perform oncoplastic procedures. Therefore, data on the efficacy of OPS in breast cancer treatment from low and middle socioeconomic country is not substantial [ 18 , [19] , [20] ]. With the advent of neo-adjuvant therapy allowing more and more breast conserving procedures to be performed and declining mortality of breast cancer patients due to advances in adjuvant treatments, more women will live with the surgical treatment decided for them.…”

Section: Introductionmentioning

confidence: 99%

Oncoplastic surgery: A suitable alternative to conventional breast conserving surgery in low - Middle income countries; a retrospective cohort study

Abidi

Vohra

Javed

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Breast Conserving Surgery (BCS) with whole breast radiation is now standard of care as a safer alternative to Mastectomy in terms of loco-regional recurrence and long-term survival. Despite this, a frequent pitfall of conventional BCS is positive surgical margins and need for second surgery with a reported frequency of 12–59 % in literature. Oncoplastic Surgery can be a safer, more cost effective alternate to conventional BCS owing to its higher rate of negative surgical margins (4–6% vs 12–59 %) and better cosmetic results. We aim to prove utility of Oncoplastic surgery for Low-Middle income countries. Objective The aim of this study was to determine Oncoplastic Surgery as a more appropriate alternative to Conventional Breast Conserving Surgery for Low-Middle Income countries in terms of its lower positive margins and re-excision rates. Methodology A retrospective comparative single center study by reviewing patient's medical records from August 2016 to June 2020 was conducted. Rate of positive margins and re-excisions along with mean volume of resection specimen, mean tumor size and quadrant dealt by both surgical procedures were compared. Results Out of 421 patients 249 patients underwent oncoplastic surgery and were compared with 173 patients who had conventional breast conserving surgery. Positive margins were seen in 5 patients (2 %) in OPS group whereas in 31 (17.9 %) patients in BCS group (p value < 0.001). Therefore, 2 from OPS group and 17 from BCS group underwent re-excision (p value < 0.002).None in OPS group while 7 out of 17 patients in BCS group underwent mastectomy as second procedure. Mean tumor size in OPS group was 2.26 cm ± SD 1.66 and in BCS group was 1.94 cm ± SD 1.28. Majority of Lobular carcinoma and Ductal carcinoma in-situ, multifocal, upper inner and central quadrant tumors and those unresponsive to neo-adjuvant therapy were treated by Oncoplastic techniques. Conclusion Oncoplastic surgery has shown promising results as a safer tool to deal with large, complex tumors, lesions in difficult anatomical locations, multifocal or progressing on neo-adjuvant therapy. With its low Re-excision rates, it is a better alternative to traditional Breast Conserving approach for overburdened and resource limited health care system of Low-Middle Income countries. Multi-center, prospective trials are needed to determine its feasibility.

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Oncoplastic Breast-Conserving Surgery in Low- and Middle-Income Countries: Training Surgeons and Bridging the Gap

Cited by 7 publications

References 41 publications

Oncoplastic surgery for breast cancer: Global perspectives and trends

Oncoplastic surgery for breast cancer: Global perspectives and trends

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

Oncoplastic surgery: A suitable alternative to conventional breast conserving surgery in low - Middle income countries; a retrospective cohort study

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