The Approach of General Surgeons to Oncoplastic and Reconstructive Breast Surgery in Turkey: A Survey of Practice Patterns

Abstract

With the wide acceptance of Fisher's theory that breast cancer is a systemic disease from the start and in the light of improvements in adjuvant treatment, the role of surgery in the treatment of cancer was expected to gradually decrease (1). However today's surgical treatment of breast cancer has developed into oncoplastic and reconstructive surgery (Oncoplastic Breast Surgery (OBS) + Reconstructive Breast Surgery (RBS) = ORBS). Besides establishing ideal regional oncological control, surgeons are often faced with the difficulties of conserving breast aesthetics or achieving optimal results. In a meta-analysis, Losken et al. reported that the rate of surgical margin involvement was 12.3% and 20.6% for patients who underwent OBS and Breast Conserving Surgery (BCS), respectively. In addition, they reported local recurrence rates of 3.6-4.7% and 7% for OBS and BCS, respectively (2). In another study comparing oncological outcomes for BCS and OBS, they reported tumour sizes of 17 mm and 24 mm, surgical margins of 6 mm and 14 mm, and rates of re-excision of 29% and 5.4%, respectively. They suggested that OBS has a positive effect on oncological perspective in breast cancer surgery (3).The Turkish Federation of Breast Disease Societies (TFBDS) made recommendations regarding ORBS at their first Breast Cancer Consensus Meeting in 2006 (4). In TurBackground: Oncoplastic Breast Surgery (OBS), which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. Aims: To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS) undertaken by general surgeons specializing in breast surgery in Turkey. Study Design: Cross-sectional study. Methods: Between December 2013 and February 2014, an elevenquestion survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS), the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS) and informing patients about ORBS preoperatively. Results:Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon). 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. Conclusion: Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques.

Post-mastectomy breast reconstruction: an overview of the state of the art, challenges, and prospects

“…27,28 In Turkey, oncoplastic surgeries are performed successfully by general (breast) surgeons with or without plastic surgeons, and it is suggested that training in oncoplastic surgery be included in mainstream surgical training. 37 Indian researchers have proposed a "one surgeon, dual role" concept-in which one surgeon is trained to perform both the oncologic and plastic surgeryas a way to reduce the cost of care and make up for the dearth of plastic surgeons. 27 In fact, Oncoplastic surgeons in India and the United Kingdom have created a comprehensive, multidisciplinary Oncoplastic Surgery Training Program.…”