The approach of general surgeons to oncoplastic and reconstructive breast surgery in Turkey: a survey of practice patterns

With the wide acceptance of Fisher’s theory that breast cancer is a systemic disease from the start and in the light of improvements in adjuvant treatment, the role of surgery in the treatment of cancer was expected to gradually decrease (1). However today’s surgical treatment of breast cancer has developed into oncoplastic and reconstructive surgery (Oncoplastic Breast Surgery (OBS) + Reconstructive Breast Surgery (RBS) = ORBS). Besides establishing ideal regional oncological control, surgeons are often faced with the difficulties of conserving breast aesthetics or achieving optimal results. In a meta-analysis, Losken et al. reported that the rate of surgical margin involvement was 12.3% and 20.6% for patients who underwent OBS and Breast Conserving Surgery (BCS), respectively. In addition, they reported local recurrence rates of 3.6–4.7% and 7% for OBS and BCS, respectively (2). In another study comparing oncological outcomes for BCS and OBS, they reported tumour sizes of 17 mm and 24 mm, surgical margins of 6 mm and 14 mm, and rates of re-excision of 29% and 5.4%, respectively. They suggested that OBS has a positive effect on oncological perspective in breast cancer surgery (3). The Turkish Federation of Breast Disease Societies (TFBDS) made recommendations regarding ORBS at their first Breast Cancer Consensus Meeting in 2006 (4). In Turkey, there is no official Breast Surgery sub-specialization available to general surgeons. However, in certain teaching and research hospitals and university hospitals a small number of general surgeons do concentrate on breast surgery. Despite current publications and national guidelines, there is disparity in surgical approaches to ORBS. This is either due to limited resources in the workplace or the knowledge and experience of the individual surgeon. Our study aims to investigate the experiences, applications and approaches to OBS and RBS taken by general surgeons who focus on breast surgery in Turkey. From our exploration of the available literature (Pubmed; Cohrane Database) we believe this to be a unique study, as it is the first survey of ORBS worldwide and in Turkey to involve such a large cohort of surgeons of this nature.