Single Versus Dual Surgeon Approaches to Oncoplastic Surgery: A Comparison of Outcomes

Geographical Presence of Plastic Surgeons in Relation to Breast Surgeons in the United States for Breast Reconstruction

BACKGROUND

Despite advancements in oncoplastic breast surgery, barriers to breast reconstruction remain, particularly in rural and suburban areas. We aimed to assess the presence of plastic surgeons performing breast reconstruction relative to breast surgeons or general surgeons performing breast cancer surgery within urban, suburban, and rural populations.

METHODS

Data were collected from the 2024 membership of the American Society of Breast Surgeons and American Society of Plastic Surgeons. Breast and plastic surgeons were totaled by state, and each breast surgeon's zip code was searched for proximity to a plastic surgeon performing reconstructive surgery within 10 or 20 miles. Zip codes were categorized by population density to determine surgeon distribution.

RESULTS

There are 1.8 times more plastic surgeons than breast surgeons. In total, 14% of breast surgeons had no plastic surgeons within 10 miles and 7% had none within 20 miles, compared to 25% and 10% in 2018. In total, 43% of breast and plastic surgeons practice in urban areas, whereas only 25% of breast surgeons and 19% of plastic surgeons practice in rural areas.

CONCLUSIONS

While access to breast reconstruction continues to improve, there are still disparities in rural areas. Efforts directed toward improving access to breast reconstruction in more rural areas should be pursued.

Trends and Perspectives in Oncoplastic Breast Surgery: Findings From a Web-Based Survey With the Korean Breast Cancer Society

PURPOSE

Oncoplastic breast surgery (OPS) is a crucial component of breast cancer surgery that combines oncological safety with improved cosmetic outcomes. OPS is increasingly being adopted worldwide, although the techniques and concepts vary based on patient demographics and surgeons' expertise. This study aimed to evaluate the evolving OPS concept among Korean breast surgeons and assess the current trends in OPS techniques.

METHODS

A web-based survey was conducted among members of the Korean Breast Cancer Society and Korean Oncoplastic Breast Surgery Study Group. The questionnaire included seven questions that explored opinions on the scope and practical trends of OPS. Respondents were stratified according to hospital type, position, and age. Data were analyzed to identify trends and differences based on demographic factors.

RESULTS

A total of 122 surgeons responded, with a majority (78.7%) working in academic or tertiary hospitals. Most respondents (77.9%) considered OPS to include volume displacement/replacement and implant-based reconstruction, regardless of the resection volume. In addition, 70.5% agreed that robotic or endoscopic surgery fell within the scope of the OPS. Autologous reconstruction after a partial mastectomy is preferred for achieving excellent cosmetic results, particularly among younger surgeons. Notably, 59.0% of the surgeons reported using single- and dual-surgeon strategies.

CONCLUSION

OPS is widely practiced among Korean breast surgeons, with the increasing adoption of advanced techniques such as robotic-assisted and endoscopic surgery. Although preferences differ with the surgeon's age, the concept of OPS has expanded considerably, and a multidisciplinary approach remains critical. Understanding these trends is essential to optimize patient care and improve surgical training programs.

Is Oncoplastic Surgery Safe in High-Risk Breast Cancer Phenotypes?

BACKGROUND

Oncoplastic surgery (OPS) has increased in popularity over the recent years. It is a form of breast conservation surgery allowing for larger partial mastectomy (PM) resections followed by either volume displacement or volume replacement reconstruction techniques. However, there is a lack of evidence on the effectiveness and safety of OPS with radiotherapy (OPS + RT) in high-risk breast cancer phenotypes, such as triple negative breast cancer (TNBC) and HER2 positive (HER2+) patients. Our aim was to compare the breast cancer-specific survival (BCSS) and postoperative surgical complications in OPS + RT compared to PM alone with radiation (PM + RT) and total mastectomy (MTX) without radiotherapy (MTX-RT).

METHODS

Patient data were analyzed from the Surveillance, Epidemiology, and End Results (SEER) cancer registries from January 1, 2012 to December 31, 2020. Patients were stratified according to the type of surgery. Cox regression analysis was performed to assess prognostic factors of BCSS.

RESULTS

A total of 24 621 patients with high-risk breast cancer phenotypes were identified, 180 underwent OPS + RT; 13 402, PM + RT; and 11 039 MTX-RT. OPS + RT was more frequently performed in younger (mean age of 65.53 years, SD: 9.29, p < 0.001), non-Hispanic White (90.5% vs. 77.7% vs. 76.3%) and single women (17.9% vs. 12.1% vs. 13.3%). MTX-RT was usually performed in patients with high histological grade, TNBC, and higher stages. Overall complication rates were higher in the MTX-RT, compared to OPS + RT and PM + RT, 2%, 1.1%, and 0.7%, respectively, p < 0.001. Rates of hematoma and surgical site infections were higher in the MTX-RT group. With a median follow-up of 46 months, OPS + RT had better BCSS rates at 5 years compared to PM + RT and MTX-RT (97.1% vs. 94.7% vs. 89.8%, p < 0.001). MTX-RT was found to be an independent prognostic factor of worse BCSS compared to OPS + RT (hazard ratio [HR] = 2.584; 95% confidence interval [CI]: 1.005-7.171), while PM + RT had no difference compared to OPS + RT (HR = 1.670, 95% CI: 0.624-4.469).

CONCLUSIONS

OPS is a safe breast surgical option in patients with HER2+ and TNBC. Patients with high-risk phenotypes who underwent OPS + RT and have similar BCSS and complication rates compared to standard breast surgical options. As such, OPS should be considered as an option whenever breast conservation surgery is being discussed.

Oncoplastic Surgery: Where Are We Now?

In the 1970s, we learned breast conservation therapy (BCT) was not inferior to mastectomy. Early BCT methods could result in deformities that were unacceptable to patients and to their surgeons. By the 1990s, surgeons began to apply the principles of plastic surgery to improve outcomes. The term oncoplastic surgery was first described in the 1990s by Werner Audretsch. We offer a review of principles, techniques, current controversies, and challenges in broadening the utilization of OPS.

Enhancing breast cancer surgery outcomes: A comprehensive review of oncoplastic techniques, surgical planning, and aesthetic considerations

Breast cancer is one of the most common types of cancer among women in Western countries. Historically treated with radical and modified radical surgeries, breast cancer is now primarily managed with breast-conserving surgery combined with postsurgical radiotherapy. Oncoplastic breast surgery, a technique that integrates aesthetic breast reduction methods with cancer surgery, has been developed as a tumor-specific approach to facilitate breast conservation while removing the tumor. This method allows for higher excision volumes with minimal aesthetic compromise. The main components of oncoplastic surgery are volume displacement and volume replacement techniques. This review discusses the essential role of oncoplastic techniques in breast-conserving surgery (BCS), which has evolved into the standard of care for early-stage breast cancer. Understanding these techniques is critical for all breast surgeons to optimize both aesthetic and oncologic outcomes.

Local practice variations and payer differences underlie state-wide disparities in oncoplastic breast surgery

BACKGROUND

Little is known about disparities in oncoplastic breast surgery delivery.

METHODS

The Massachusetts All-Payer Claims Database was queried for patients who received lumpectomy for a diagnosis of breast cancer. Oncoplastic surgery was defined as adjacent tissue transfer, complex trunk repair, reduction mammoplasty, mastopexy, flap-based reconstruction, prosthesis insertion, or unspecified breast reconstruction after lumpectomy.

RESULTS

We identified 18 748 patients who underwent lumpectomy between 2016 and 2020. Among those, 3140 patients underwent immediate oncoplastic surgery and 436 patients underwent delayed oncoplastic surgery. Eighty-one percent of patients who underwent oncoplastic surgery did so in the same county as they underwent a lumpectomy. However, the relative frequency of oncoplastic surgery varied significantly among counties. In multivariable regression, public insurance status (odds ratio: 0.87, 95% confidence interval: 0.80-0.95, p = 0.002) was associated with lower odds of undergoing oncoplastic surgery, even after adjusting for macromastia, other comorbidities, and county of lumpectomy. Average payments for lumpectomy with oncoplastic surgery were more than twice as high from private insurers ($840 vs. $1942, p < 0.001).

CONCLUSION

Disparities in the receipt of oncoplastic surgery were related to differences in local practice patterns and the type of insurance patients held. Expanding services across counties and considering billing reform may help reduce these disparities.

The Canadian Breast Cancer Symposium 2023 Meeting Report

On 15-16 June 2023, healthcare professionals and breast cancer patients and advocates from across Canada met in Toronto, Ontario, for the 2023 Canadian Breast Cancer Symposium (CBSC.). The CBSC. is a national, multidisciplinary event that occurs every 2 years with the goal of developing a personalized approach to the management of breast cancer in Canada. Experts provided state-of-the-art information to help optimally manage breast cancer patients, including etiology, prevention, diagnosis, experimental biology, and therapy of breast cancer and premalignant breast disease. The symposium also had the objectives of increasing communication and collaboration among breast cancer healthcare providers nationwide and providing a comprehensive and real-life review of the many facets of breast cancer. The sessions covered the patient voice, the top breast cancer papers from different disciplines in 2022, artificial intelligence in breast cancer, systemic therapy updates, the management of central nervous system metastases, multidisciplinary management of ductal carcinoma in situ, special populations, optimization-based individual prognostic factors, toxicity management of novel therapeutics, survivorship, and updates in surgical oncology. The key takeaways of these sessions have been summarized in this conference report.

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

BACKGROUND

Obesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI.

METHODS

Patient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005-2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound-related).

RESULTS

From a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m2 ), 737 Class 2 obesity (BMI: 35 to <40 kg/m2 ), and 541 Class 3 obesity (BMI: ≥ 40 kg/m2 ). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03-2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24-2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission.

CONCLUSIONS

Oncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m2 ), given there was a higher rate of overall and wound-specific complications, compared with patients who were not obese or had Class 1 obesity.