Oncoplastic and reconstructive breast surgeon performance and impact on breast reconstructions: Clinical outcomes, learning curve, and patients' satisfaction. (April 2023)

• Record Type: Journal Article
• Authors: Lai, Hung-Wen; Lin, Joseph; Sae-Lim, Chayanee; Lin, Ying-Jen; Chen, Dar-Ren; Lai, Yuan-Chieh; Lin, Shih-Lung; Chen, Shou-Tung
• Is Part Of: Surgical oncology. Volume 47(2023)
• Publication Date: 2023-04
• Subjects: Breast reconstruction -- Oncoplastic and reconstructive breast surgeon -- Nipple sparing mastectomy -- Learning curve -- Oncoplastic breast surgery; ORBS oncoplastic reconstructive breast surgeon -- NSM nipple sparing mastectomy -- PS plastic surgeon -- BS breast surgeon -- IBR immediate breast reconstruction -- LD Latissimus dorsi -- TRAM transverse rectus abdominis myocutaneous -- IGBR immediate gel implant breast reconstruction -- CUSUM cumulative sum -- BMI body mass index -- SD standard deviation; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2023.101920
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: Compared to mastectomy alone, the addition of breast reconstruction could improve quality of life and it is usually performed by two-team approach, which consisted of both breast surgeons and plastic surgeons. This study aims to illustrate the positive impacts of the dual-trained oncoplastic reconstructive breast surgeon (ORBS) and reveal the factors influencing reconstruction rates. Methods: This retrospective study enrolled 542 breast cancer patients who undergone mastectomy with reconstruction performed by a particular ORBS between January 2011 and December 2021 at a single institution. Clinical and oncological outcomes, impact of case accumulation on performance and patient-reported aesthetic satisfactions were analyzed and reported. Furthermore, in this study 1851 breast cancer patients treated with mastectomy combined with or without breast reconstructions, which included 542 performed by ORBS, were reviewed to identify factors affecting breast reconstructions. Results: Among the 524 breast reconstructions performed by the ORBS, 73.6% were gel implant reconstructions, 2.7% were tissue expanders, 19.5% were transverse rectus abdominal myocutaneous (TRAM) flaps, 2.7% were latissimus dorsi (LD) flaps, 0.8% were omentum flaps, and 0.8% involved LD flaps and implants. There was no total flap loss in the 124 autologous reconstructions, and the implant loss rate was 1.2% (5/403). Patient-reported aesthetic evaluations showed that 95% of the patients were satisfied. As the ORBS's accumulated case experiences, the implant loss rate decreased, and the overall satisfaction rate increased. According to the cumulative sum plot learning curve analysis, it took 58 procedures for the ORBS to shorten the operative time. In multivariate analysis, younger age, MRI, nipple sparing mastectomy, ORBS, and high-volume surgeon were factors related to breast reconstruction. Conclusion: The current study demonstrated that a breast surgeon after adequate training could become an ORBS and perform mastectomies with various types of breast reconstruction with acceptable clinical and oncological outcomes for breast cancer patients. ORBSs could increase breast reconstruction rates, which remain low worldwide. Highlights: Breast reconstructions can improve cosmetic outcome and health-related quality of life in breast cancer patients. A breast surgeon trained as an oncoplastic reconstructive breast surgeon (ORBS) can perform adequate breast reconstructions. Accumulation of ORBS experiences provides shorter operative time, less implant loss and increase patients' satisfaction. In contrary of two-surgeons approach, the one-stop ORBS is the solution for underperformed breast reconstructions worldwide.