National survey on attitudes of Brazilian breast surgeons regarding oncoplastic surgery: success of a training model

Abstract

Introduction: Historically, breast reconstruction was performed by plastic surgeons. The Brazilian Society of Mastology implemented initiatives designed to improve breast surgeons’ training in oncoplastic techniques; however, the current proportion of surgeons performing these techniques remained unknown. Objective: This study aimed to determine the proportion of Brazilian breast surgeons performing oncoplastic surgery, their previous training, the complexity of procedures performed, and factors influencing the adoption of techniques. Methods: In this survey, a structured questionnaire was sent to all Brazilian Society of Mastology-affiliated breast surgeons between July and December 2023. Outcome proportions were estimated using binomial distribution. Adjusted proportion ratios (aPR) were calculated using robust Poisson regression. Results: A 60.2% valid response rate was achieved (n=1,059/1,759). Almost half of the respondents performed oncoplastic surgery, with most being young (<40 years) (aPR 1.66; 1.31–1.10; p<0.001); male (aPR 1.39; 1.22–1.59; p<0.001); Southern resident (aPR 1.39; 1.18–1.63; p<0.001); with a specialist degree in breast disease (aPR 1.19; 1.00–1.42; p<0.004); primarily trained in general surgery (aPR 1.32; 1.16–1.51; p<0.001) and secondarily in breast surgery (aPR 1.41; 1.08–1.85; p=0.01); and performing >100 surgeries/year (aPR 1.72; 1.49–1.99; p<0.001). The techniques most commonly mastered were simple displacement (88.7%), therapeutic mammoplasty or contralateral symmetrization (96.4%), reconstruction with implants or tissue expanders (93.6%), extreme oncoplasty (81%), skin and nipple-sparing (99%), skin-reducing mastectomy (84.2%), and thoracoabdominal flaps (71.7%). Conclusion: A high proportion of Brazilian mastologists perform oncoplastic surgery, which ultimately may benefit breast cancer patients, increasing the rate of breast-conserving surgery and breast reconstruction, particularly in locations where resources are sparse. These data may encourage the development of strategies aimed at improving medical education in this field and in other countries.