Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England.
BACKGROUND
Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown.


METHODS
Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding.


RESULTS
We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease.


CONCLUSIONS
There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.
Queen Elizabeth Hospital NHS Foundation Trust, Birmingham B15 2TH, UK.
Shweta
S
Aggarwal
Queen Elizabeth Hospital NHS Foundation Trust, Birmingham B15 2TH, UK.
Sekhar
S
Marla
Queen Elizabeth Hospital NHS Foundation Trust, Birmingham B15 2TH, UK.
Donald
D
Nyanhongo
Queen Elizabeth Hospital NHS Foundation Trust, Birmingham B15 2TH, UK.
Sita
S
Kotecha
Queen Elizabeth Hospital NHS Foundation Trust, Birmingham B15 2TH, UK.
Narendra Nath
NN
Basu
D001943:Breast Neoplasms / Q000601:surgery*; D059019:Clinical Coding; D000075202:Contraindications; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016462:Mammaplasty / Q000379:methods / Q000592:standards*; D018579:Patient Selection; D012907:Smoking / Q000009:adverse effects; D066231:Surgeons / Q000706:statistics & numerical data; D013524:Surgical Flaps; D011795:Surveys and Questionnaires