The adoption of oncoplastic surgery: Is there a learning curve?

Abstract

Introduction: Oncoplastic surgery (OPS) is a form of breast conservation surgery involving partial mastectomy followed by volume displacement or replacement surgery. As the field of OPS is growing, we sought to determine if there was a learning curve to this surgery.Methods: A retrospective chart review was conducted of all patients who underwent OPS over a 6-year period with a single surgeon formally trained in both Plastic Surgery and Breast Oncology. Cumulative summation analysis (CUSUM) was performed on mean operative time to generate the learning curve and learning curve phases. Outcomes were compared between phases to determine significance.Results: Mean operative time decreased significantly across the 6-year period, generating three distinct learning curve phases: Learner phase (cases 1−23), Competence phase (24−73), and Mastery phase (74 and greater). The overall positive margin rate was 10.9% and there was no significant difference in rates between phases (p = 0.49). Overall complication rates, reoperation rates, and locoregional recurrence remained the same across all phases (p = 0.16; p = 0.65; p = 0.41). The rate of partial nipple loss decreased between phases (p = 0.02). Conclusion:As with many complex operations, there does appear to be a learning curve with OPS, as the operative time and the rates of partial nipple loss decreased over time.

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

“…The frequency of the following factors increased with BMI, independent of the type of analysis: diabetes mellitus (nonobese (6.5%) vs. Class 1 (17.9%) vs. Class 2 (23.9%) vs. Class 3 (32.5%), p < 0.001); hypertension (32.2% vs. 51.9% vs. 60.0% vs. 65.4%, p < 0.001); protein malnutrition (albumin <3.5 g/dL, 3.6% vs. 4.4% vs. 5.8% vs. 10.6%, p < 0.001); creatinine (0.80 mg/dL vs. 0.83 mg/dL vs. 0.85 mg/dL vs. 0.89 mg/ dL, p < 0.001); and operative risk, as predicted by the preoperative American Society of Anesthesiologists (ASA) physical status classification score (2.16 vs. 2.36 vs. 2.50 vs. 2.77, p < 0.001). 14 Moreover, a greater operative time was found as BMI increased (86.7 min vs. 94.7 min vs. 100.6 min vs. 99.6 min, p < 0.001). On the other hand, the groups did not differ significantly in number of outpatient versus inpatient procedures, smoking status, metastatic cancer, steroid use, or hematocrit levels (Table 1).…”

“…[30][31][32] While operative times may increase with a higher BMI given that there may be more tissue to dissect and reconstruct, physician experience in oncoplastic surgery also plays an independent role in OR time efficiency, with an increased experience level leading to less operative time. 14 As such, the results of this study may help facilitate the allocation of high BMI cases being delegated to experienced oncoplastic surgeons to offset the general increase in associated higher BMI cases.…”

“…[6][7][8][9] Oncoplastic surgery is increasing in prevalence as a breast cancer surgery option in the United States 10,11 and its safety has been well documented. [12][13][14] In general, a higher BMI has been associated with a higher risk of complications in breast cancer operations involving major tissue dissection and reconstruction. [15][16][17] Hence, with a steady rise in both breast cancer and the prevalence of obesity, we sought to evaluate the complication rates in oncoplastic surgery.…”

Practical oncoplastic surgery techniques needed for practice

“…Whomever makes the commitment to provide OPS techniques, previous literature is promising in that there is a quick learning curve. A retrospective review of over 200 patients over six years demonstrated competency in performing OPS after 24 procedures and mastery after 74 procedures ( 35 ), speaking to the necessity of training both breast and plastic surgeons in the surgical techniques that offer the best oncologic and aesthetic outcomes for eligible patients.…”