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Wareham C, Bertaux B, Chahine E, Homsy C, Perry D, Persing S, Nardello S, Chatterjee A. Geographical Presence of Plastic Surgeons in Relation to Breast Surgeons in the United States for Breast Reconstruction. J Surg Oncol 2025. [PMID: 40365817 DOI: 10.1002/jso.28144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 03/27/2025] [Accepted: 03/31/2025] [Indexed: 05/15/2025]
Abstract
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.
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Affiliation(s)
- Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Brittany Bertaux
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Elsa Chahine
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dylan Perry
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sarah Persing
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Division of Surgical Oncology and Breast Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Nardello
- Department of Surgery, Division of Surgical Oncology and Breast Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Division of Surgical Oncology and Breast Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Lee J, Kang B, Park HY, Kang SY, Kim MK, Kim HK, Min SY, Seong MK, Yoo TKR, Lee S, Lee ES, Yoon KH, Kim EK, Korean Oncoplastic Breast Surgery Study Group (KOPBS). Trends and Perspectives in Oncoplastic Breast Surgery: Findings From a Web-Based Survey With the Korean Breast Cancer Society. J Breast Cancer 2025; 28:28.e13. [PMID: 40432350 DOI: 10.4048/jbc.2024.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 01/14/2025] [Accepted: 03/08/2025] [Indexed: 05/29/2025] Open
Abstract
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.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byeongju Kang
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Yull Kang
- Department of Surgery, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Min Kyoon Kim
- Department of Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University Seoul, Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Young Min
- Department of Surgery, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Tae-Kyung Robyn Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Eun-Shin Lee
- Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Hwak Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Ku GDLC, Wareham C, King C, Koul A, Desai A, Persing SM, Nardello S, Chatterjee A. Is Oncoplastic Surgery Safe in High-Risk Breast Cancer Phenotypes? J Surg Oncol 2025; 131:133-142. [PMID: 39285642 DOI: 10.1002/jso.27899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/16/2024] [Accepted: 09/03/2024] [Indexed: 04/29/2025]
Abstract
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.
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Affiliation(s)
- Gabriel De La Cruz Ku
- Department of Surgery, Universidad Cientifica del Sur, Lima, Peru
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Caroline King
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Akash Koul
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Anshumi Desai
- Department of Surgery, University of Miami Medical School, Miami, Florida, USA
| | - Sarah M Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Nardello
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Clark P, DiPasquale A, Cocco D, Brown A, Brown A. Oncoplastic Surgery: Where Are We Now? J Surg Oncol 2025; 131:124-132. [PMID: 39574213 DOI: 10.1002/jso.27665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2025]
Abstract
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.
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Affiliation(s)
- Patricia Clark
- Parkview Packnett Family Cancer Institute, Fort Wayne, Indiana, USA
| | | | - Daniela Cocco
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew Brown
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Ashley Brown
- Ironwood Cancer and Research Centers, Phoenix, Arizona, USA
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Mennati M, Moeinafshar A, Rezaei N. Enhancing breast cancer surgery outcomes: A comprehensive review of oncoplastic techniques, surgical planning, and aesthetic considerations. Crit Rev Oncol Hematol 2025; 206:104578. [PMID: 39608594 DOI: 10.1016/j.critrevonc.2024.104578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 11/23/2024] [Accepted: 11/24/2024] [Indexed: 11/30/2024] Open
Abstract
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.
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Affiliation(s)
- Mehrsa Mennati
- Medical Student, Tehran Medical Science Branch, Islamic Azad University, Tehran, Iran
| | - Aysan Moeinafshar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Yang AZ, Hyland CJ, Miller AS, Killelea BK, Starr BF, Broyles JM. Local practice variations and payer differences underlie state-wide disparities in oncoplastic breast surgery. J Surg Oncol 2024; 130:210-221. [PMID: 38941173 DOI: 10.1002/jso.27755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/17/2024] [Accepted: 06/14/2024] [Indexed: 06/30/2024]
Abstract
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.
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Affiliation(s)
- Alan Z Yang
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Brigid K Killelea
- Division of Breast Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Justin M Broyles
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Cil T, Boileau JF, Chia S, DeCoteau MJ, Jerzak KJ, Koch A, Nixon N, Quan ML, Roberts A, Brezden-Masley C. The Canadian Breast Cancer Symposium 2023 Meeting Report. Curr Oncol 2024; 31:1774-1802. [PMID: 38668038 PMCID: PMC11049169 DOI: 10.3390/curroncol31040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Tulin Cil
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | | | - Stephen Chia
- British Columbia Cancer Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada;
| | - MJ DeCoteau
- Rethink Breast Cancer, Toronto, ON M4M 3G3, Canada;
| | - Katarzyna J. Jerzak
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
| | - Anne Koch
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | - Nancy Nixon
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - Amanda Roberts
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
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De La Cruz Ku G, Camarlinghi M, Mallouh MP, Torres-Roman JS, Linshaw D, Persing SM, Nardello S, Chatterjee A. The impact of body mass index on oncoplastic breast surgery: A multicenter analysis. J Surg Oncol 2023; 128:1052-1063. [PMID: 37448232 DOI: 10.1002/jso.27397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
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.
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Affiliation(s)
- Gabriel De La Cruz Ku
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Universidad Cientifica del Sur, Lima, Peru
| | | | - Michael P Mallouh
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - J Smith Torres-Roman
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
| | - David Linshaw
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sarah M Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Nardello
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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