Oncoplastic breast surgery: a regional Australian 2012 fellowship experience

Oncoplastic breast surgery (OBS) is a developing subspecialty, although many countries are struggling with how to incorporate training in OBS as part of the established breast surgery subspecialization pathways. UK and Brazil have surged ahead with established formal training programmes, whereas countries such as Australia still rely on ad hoc training by interested surgeons. Our aim was to review the possibility of including regional training centres with appropriate OBS expertise into a future formal training programme in OBS.

An 11-month self-audit was performed by the Fellow based in Port Macquarie, in a Breast Surgeons Society of Australia and New Zealand Incorporated accredited Fellowship. The audit template and reconstructive database, which were utilized in this study were supplied by Breast Surgeons Society of Australia and New Zealand Incorporated.

OBS procedures made up 41% of total breast procedures performed, with 46% of these being performed by the Fellow. These oncoplastic procedures included 22 reconstructive breast procedures, with 15 (68%) being performed by the Fellow. These procedures involved mainly pedicle transverse rectus abdominis myocutaneous flap reconstruction after mastectomy and breast implant reconstruction techniques. Minor and major complications accounted for a small percentage of operated cases and are discussed.

Current British Association of Surgical Oncology (BASO) guidelines specify recommendations regarding BASO Level I and II OBS training, experience and exposure. Based on the experience during the fellowship presented in this audit, we discuss the merits of using regional Australian hospitals like Port Macquarie Base Hospital to make up the cohort of BASO Level I units to provide the core foundation experience in OBS to the next generation of Australian oncoplastic breast fellows.