RESUMO
Oncoplastic breast surgery (OBS) is an established field of surgery bringing together oncological and reconstructive principles to the surgical management of breast disease, which is yet to make inroads into some areas of Australia and New Zealand (A&NZ). Both patients and medical fraternity are supportive of these approaches and improved quality of life and aesthetic outcomes resulting from their application. Oncological outcomes have been shown to be no different when these oncoplastic approaches are utilised. There is a broad interest amongst breast surgeons regarding OBS and development of their own skills. However a new and improved method of training the current and the next generation of breast surgeons is required. This has already begun in some countries such as the UK, but is slower in A&NZ region. Some of the obstacles in training of OBS to the next generation of surgeons are discussed and highlighted.This year first steps in formalised training approaches are being made. The future of breast surgery is likely to involve OBS as part of mainstream surgical management of breast disease.
RESUMO
INTRODUCTION: Oncoplastic breast surgery (OBS) is a developing subspecialty, although many countries are struggling with how to incorporate training in OBS as part of the established breast surgery subspecialization pathways. UK and Brazil have surged ahead with established formal training programmes, whereas countries such as Australia still rely on ad hoc training by interested surgeons. Our aim was to review the possibility of including regional training centres with appropriate OBS expertise into a future formal training programme in OBS. METHODS: An 11-month self-audit was performed by the Fellow based in Port Macquarie, in a Breast Surgeons Society of Australia and New Zealand Incorporated accredited Fellowship. The audit template and reconstructive database, which were utilized in this study were supplied by Breast Surgeons Society of Australia and New Zealand Incorporated. RESULTS: OBS procedures made up 41% of total breast procedures performed, with 46% of these being performed by the Fellow. These oncoplastic procedures included 22 reconstructive breast procedures, with 15 (68%) being performed by the Fellow. These procedures involved mainly pedicle transverse rectus abdominis myocutaneous flap reconstruction after mastectomy and breast implant reconstruction techniques. Minor and major complications accounted for a small percentage of operated cases and are discussed. DISCUSSION: Current British Association of Surgical Oncology (BASO) guidelines specify recommendations regarding BASO Level I and II OBS training, experience and exposure. Based on the experience during the fellowship presented in this audit, we discuss the merits of using regional Australian hospitals like Port Macquarie Base Hospital to make up the cohort of BASO Level I units to provide the core foundation experience in OBS to the next generation of Australian oncoplastic breast fellows.