Training Canadian surgeons in oncoplastic breast surgery: Where do we stand?

Khayat, Eman; Brackstone, Muriel; Maxwell, Jessica E.; Hanrahan, Renee; Richardson, J. C.; Kappala, Marianna; Arnaout, Angel

doi:10.1503/cjs.001217

Cited by 15 publications

(14 citation statements)

References 3 publications

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“…Upper level procedures include reduction mammoplasty, augmentation mammoplasty, mastopexy with implant placement and immediate reconstruction with implants. Highest level reconstructive methods also include implant-based reconstruction, and pedicled or free flap reconstruction 5 , 10 , 11 (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Key Areas for Development in Oncoplastic Breast Reconstruction

Molina

Shelby

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Oncoplastic breast reconstruction addresses lumpectomy or partial mastectomy defects after breast conserving surgery. A large subset of breast cancer patients may be candidates for oncoplastic partial breast reconstruction, but are likely underserved in the United States due to multiple factors. In this article, the authors provide an understanding of current trends in the literature and an overview of key areas for improvement in the delivery of breast cancer surgical care. Methods: A literature search of peer-reviewed articles relating to oncoplastic breast reconstruction was performed. In addition, current US laws relating to breast reconstruction, and communication and content from key surgical societies were reviewed. Key areas of improvement were identified after qualitative review of all sources. Results: Thirty-four relevant resources were included. There is a large potential population need for oncoplastic breast reconstruction, but no current accurate estimate of patients undergoing this type of reconstruction. There are a multitude of definitions and algorithms attempting to define and organize oncoplastic breast surgery. Legislative initiatives could be improved to prevent coverage gaps. Coding and billing for oncoplastic surgery is not standardized, which complicates both clinical implementation and research efforts. Collaboration between national societies is needed. Conclusions: Oncoplastic partial breast reconstruction is an important part of the total package of care that can be offered to the breast cancer patient. Improvements in legislation, coding, and billing, and unification of national society communications and initiatives can lead to better surgical outcomes for the breast cancer patient.

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Section: Discussionmentioning

confidence: 99%

Key Areas for Development in Oncoplastic Breast Reconstruction

Molina

Shelby

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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“…Two separate publications have not only described the current fellow's logbook, demonstrating a wide range of oncoplastic and reconstructive surgical procedures, but also summarized oncoplastic training opportunities in Canada. 10,11 The University of Ottawa offers a dedicated oncoplastic and research fellowship that includes exposure to breast reconstruction. The University of Toronto breast surgical oncology fellowship offers a one-year breast surgical oncology program that includes exposure to oncoplastic surgery.…”

Section: Existing Training Opportunitiesmentioning

confidence: 99%

Oncoplastic and reconstructive breast surgery in Canada: breaking new ground in general surgical training

Peiris

Olson

Dabbs

2018

cjs

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Oncoplastic breast surgery combines certain plastic surgery procedures with a breast cancer resection to minimize the cosmetic penalty. We compared current practices in breast surgery in Canada and the UK, looking at the classification of oncoplastic breast surgery, management of larger tumours that would otherwise mandate a mastectomy, and the breast surgeon’s role in immediate breast reconstruction. Reconstructive breast surgery has always fallen within the domain of the plastic surgeon, but surgical subspecialization and more focused fellowship training have meant that breast surgeons with the appropriate skillset can offer these procedures. This evolution of the breast surgeon has led to the birth of a new field of breast surgery known as oncoplastic and reconstructive breast surgery. Those tasked with developing surgical training programs in Canada must now decide whether to train breast surgeons in these techniques to improve long-term quality of life among Canadian patients with breast cancer.

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“…However, there are equally important factors limiting the rates of breast reconstruction, including a persistent and erroneous belief among ablative surgeons and medical and radiation oncologists that reconstruction will delay adjuvant therapies or "hide" tumour recurrence. 5 Finally, a lack of dedicated operative resources for breast reconstruction is a significant impediment because it requires complex coordination among general surgeons and reconstructive surgeons, and there is a legitimate concern on the part of general surgeons that their already scarce operative time will be taken up with potentially long reconstructive procedures after they have completed a mastectomy. In our institution, dedicated ablative/reconstructive operating time allows both plastic surgeons and general surgeons to run concurrent clinics and surgical lists once they have completed their portion of the breast procedure.…”

mentioning

confidence: 99%

“…The ISCP syllabus for general surgical trainees in the UK wishing to pursue a career in breast surgery lists both immediate and delayed implantonly breast reconstruction and implant-assisted pedicled-latissimus dorsi breast reconstruction as procedures that qualifying trainees should be "competent to perform without assistance and deal with the complications that arise." 5 All qualifying British general surgeons wishing to perform breast surgical oncology should therefore have this skill set as a minimum requirement. Dr Ross's second point relates to a "persistent and erroneous belief amongst ablative surgeons and medical and radiation oncologists that reconstruction will delay adjuvant therapies or 'hide' tumour recurrence."…”

mentioning

confidence: 99%

Breast reconstruction: no need to “break new ground”

Ross

2019

cjs

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Training Canadian surgeons in oncoplastic breast surgery: Where do we stand?

Cited by 15 publications

References 3 publications

Key Areas for Development in Oncoplastic Breast Reconstruction

Key Areas for Development in Oncoplastic Breast Reconstruction

Oncoplastic and reconstructive breast surgery in Canada: breaking new ground in general surgical training

Breast reconstruction: no need to “break new ground”

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