title: Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.
abstract: Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation.
  
  
  
  A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers.
  
  
  
  A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor.
  
  
  
  Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Maxwell
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roberts
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Tulin
authors.initials: T
authors.lastname: Cil
authors.affiliation: University of Toronto, Toronto, Canada.|North York General Hospital, North York, ON, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Somogyi
authors.affiliation: North York General Hospital, North York, ON, Canada. fahima.osman@nygh.on.ca.
authors.forename: Fahima
authors.initials: F
authors.lastname: Osman
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D002983:Clinical Competence; D004954:Esthetics; D005260:Female; D013502:General Surgery / Q000193:education / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms; D012737:Sex Factors; D013518:Surgery, Plastic / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires