Current Practices and Trends of Plastic and Oncoplastic Breast Surgeons in Canada

Background: There is a lack of previous studies investigating oncoplastic practice trends for breast reconstruction in Canada, particularly from the plastic surgeon perspective. Given the rising popularity of oncoplastic techniques, this study aimed to identify current practice trends for breast and plastic surgeons in Canada. Methods: A cross-sectional survey study of breast and plastic surgeons performing oncoplastic surgery across Canada was conducted. Results: Ninety-five surgeons were invited to complete the survey, with 58 respondents (response rate 61%), of which 29 (50.0%) were breast surgeons and 29 (50.0%) were plastic surgeons. Compared to plastic surgeons, breast surgeons performed significantly more level 1 surgeries (27.6 vs 3.45%, P < .001). Plastic surgeons performed more level 2 (37.9% vs 13.8%, P = .0475) and level 3 (31.4% vs 10.3%, P = .00814) surgeries. Breast surgeons identified significant perceived barriers including unfamiliarity with techniques (P = .00513), adjuvant therapy delays (P = .00612), lack of plastic surgery support (P < .001), lack of radiation oncology support (P = .0485), increased OR time (P < .001), lack of OHIP billing codes (P < .001), and post-operative complication management (P = .0372). Breast surgeon comfort with oncoplastic techniques was not correlated with practice duration (R-square = .037, P-value = .853). Breast surgeon comfort with contralateral surgery was not correlated with practice setting (R-square = .071, P-value = .632). Conclusions: Breast surgeons perceive a lack of training, a lack of support from plastic surgery, concerns regarding appropriate financial remuneration, and worries of increased OR time as barriers in oncoplastic surgery. Collaboration between general breast surgery and plastic surgery is needed for improving training options for oncoplastic surgery in Canada and for providing excellent breast cancer care overall.