Training Oncoplastic Breast Surgeons: The Canadian Fellowship Experience

J Maxwell,M Brackstone,R Hanrahan,A Arnaout

doi:10.3747/co.24.3554

Abstract

Oncoplastic breast surgery combines traditional oncologic breast conservation with plastic surgery techniques to achieve improved aesthetic and quality-of-life outcomes without sacrificing oncologic safety. Clinical uptake and training remain limited in the Canadian surgical system. In the present article, we detail the current state of oncoplastic surgery (ops) training in Canada, the United States, and worldwide, as well as the experience of a Canadian clinical fellow in ops. The clinical fellow undertook a 9-month audit of breast surgical cases. All cases performed during the fellow's ops fellowship were included. The fellowship ran from October 2015 to June 2016. During the 9 months of the fellowship, 67 mastectomies were completed (30 simple, 17 modified radical, 12 skin-sparing, and 8 nipple-sparing). The fellow participated in 13 breast reconstructions. Of 126 lumpectomies completed, 79 incorporated oncoplastic techniques. The experience of the most recent ops clinical fellow suggests that Canadian ops training is feasible and achievable. Commentary on the current state of Canadian ops training suggests areas for improvement. Oncoplastic surgery is an important skill for breast surgical oncologists, and access to training should be improved for Canadian surgeons.

Highlights

Breast cancer is the most common cancer affecting Canadian women, and the 2nd leading cause of female cancer deaths
The experience of the most recent ops clinical fellow suggests that Canadian ops training is feasible and achievable
Oncoplastic surgery is an important skill for breast surgical oncologists, and access to training should be improved for Canadian surgeons

Summary

Introduction

Breast cancer is the most common cancer affecting Canadian women, and the 2nd leading cause of female cancer deaths. The evolving nature of breast cancer care requires that the management of breast disease be an important part of surgical education programs from residency through fellowship. In a 2012 survey, graduating residents indicated that they were uncomfortable discussing the complexities of medical management of breast cancer care with patients[2]. With a growing number of clinicians dedicating their practice to breast disease, and given the advances in breast cancer care, the Society of Surgical Oncology (sso) began training fellows in recognized U.S programs in 2004. The University of Toronto began its breast fellowship training program in 2002, accepting 1–2 fellows annually. Western University in London, Ontario, trained its first breast ablative and reconstructive surgery fellow in 2007 and has accepted trainees sporadically since . We detail the current state of oncoplastic surgery (ops) training in Canada, the United States, and worldwide, as well as the experience of a Canadian clinical fellow in ops

Results

Discussion

Conclusion