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The Current State of Oncoplastic Breast Surgery in Plastic and Reconstructive Surgery Training
Oncoplastic breast surgery is a useful oncologic and reconstructive technique that allows for both improved oncologic margins as well as aesthetic outcomes.1 However, oncoplastic education is not standardized in plastic and reconstructive surgery training and experience varies greatly. Currently, oncoplastic breast surgery is not a training requirement for the American Board of Plastic Surgery. In addition to understanding reconstructive concepts for the breast, plastic surgery trainees would also need to obtain a critical understanding of oncologic principles, pathological diagnosis and margin control, radiotherapy and its effects on breast reconstruction, adjuvant and neoadjuvant chemotherapy, and clinical/imaging follow-up.2
Historically, the broad scope of plastic and reconstructive surgery has resulted in increasing overlaps with various other specialties. For example, hand surgery is shared with orthopedic surgery, cosmetic surgery is shared with dermatology, craniofacial surgery is shared with otolaryngology, and abdominal wall reconstruction is shared with general surgery.3 Whereas microvascular and free flap breast procedures are undoubtedly within the realm of plastic surgery only, we are now in a shift of increasing overlap of breast reconstruction with breast surgery. A qualitative study of attitudes towards oncoplastic surgery in Australia revealed perceptions of professional jealousy, workload capacity, the old versus new guard, and opinions that reconstructive surgery should be left to the experts.4
Despite controversies over this movement, oncoplastic surgery has resulted in more opportunities for breast cancer patients to have access to immediate breast reconstruction. Geographic location and access to plastic surgeons have long been cited as reasons for increasing oncoplastic surgery exposure for general/breast surgeons.5 Given that oncoplastic breast surgery will only continue to grow and expand, it is critical for plastic surgery trainees to join this movement in order to remain at the forefront of breast reconstruction.
Acknowledgments
Affiliations: 1Department of Surgery, Tufts Medical Center, Boston, MA; 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; 3Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Kentucky, Lexington, KY; 4Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, MA
Correspondence: Joshua A Bloom, MD; bloomjosha@gmail.com
Disclosures: The authors disclose no relevant financial or nonfinancial interests.
References
1. Chatterjee A, Gass J, Patel K, et al. A consensus definition and classification system of oncoplastic surgery developed by the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26(11):3436-3444. doi:10.1245/s10434-019-07345-4
2. Pires DM, Junior OG, Valadares CN, Andrade RL. Training in oncoplastic and reconstructive breast surgery: analysis of training in America and in the European Union with the Brazilian Reality. Mastology. 2017;27(2):164-171. doi:10.5327/ Z2594539420170000185
3. Losken A, Nahabedian MY. Oncoplastic breast surgery: past, present, and future directions in the United States. Plast Reconstr Surg. 2009;124(3):969-972. doi:10.1097/ PRS.0b013e3181b038ec
4. Flitcroft K, Brennan M, Spillane A. On the frontiers of change: breast surgeons’ views on demarcation between surgical sub-specialities in Australia. ANZ J Surg. 2020;90:317-24.
5. Urban CA. Oncoplastic in a pre-paradigm era: a Brazilian perspective in an American problem. Plast Reconstr Surg. 2010;125(6):1839-1841. doi:10.1097/ PRS.0b013e3181cb61d5
