Wednesday, July 09, 2008

What's oncoplastic surgery?

The Wall Street Journal profiled the concept of "Oncoplastic Breast Surgery". This is conceptually just lumpectomy or mastectomy done better. The concept uses rotating breast tissue to fill defects at the time of lumpectomy or larger "quadrantectomy" procedures. These are maneuvers we use with breast reduction and mastopexy procedures adapted to some of the cancer surgery procedures.

It's a nice concept, but the rate-limiting step here is getting general surgeons to change how they think about breast surgery. Trying to coordinate someone else during the resection with a reconstruction is difficult, as they don't "think" like plastic surgeons do. I'm skeptical that short courses to surgeons can teach much beyond the most simple techniques. It's like putting someone in front of Guitar Hero on the Wii or Playstation and expecting them to play guitar professionally afterwards.

I'm constantly evaluating blood supply, tension, and tissue quality in a way that you just don't get taught in other specialties. Weekend courses in this discipline just aren't the same as having doing hundreds of different possible reconstructive techniques all over the body and bringing that to bear on a given case. I had the pleasure of working with two of the leaders in this field during my breast surgery fellowship, in Plastic Surgeon Dr. Pat Maxwell and (an occasional basis) Breast Cancer Surgeon, Dr. Pat Whitworth in Nashville. I though I knew how to do mastectomies and whatnot before I saw these guys do their thing. They're incredible! Both do such anatomically sound breast procedures with no superfluous steps that it's really beautiful (for lack of a better word) to watch. Dr. Whitworth is quoted in the article BTW.



DrB said...

I did my hand fellowship after a full general surgery residency. During hand, being the only fellow, I was exposed to/ assisted on TONS of reconstructive surgery. It definitely gave me a new way of approaching general surgery. I can certainly appreciate your comment in that it is very difficult to change a general surgeon's thinking when it comes to approaches to breast surgery. But I am one you won't have to worry about. :)

Anita said...

read two articles lately that seem to offer new treatment options for breast cancer patients following mastectomy and removing the lumps which might occur following the treatment...

Sounds interesting to say the least:

and here:

whats your take on this?