The Adoption of Oncoplastic Surgery: Is There a Learning Curve?
Manish M. Karamchandani, MD1, Michael M. Jonczyk, MD, MS2, Gabriel De La Cruz Ku, MD3, Kerry A. Gaffney, MD1, Carly Wareham, MD1, Sarah M. Persing, MD, MPH4,5, Christopher Homsy, MD4, Abhishek Chatterjee, MD, MBA4,5
1Department of Surgery, Tufts Medical Center, Boston, MA; 2Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA; 3Department of Surgery, UMass Memorial Medical Center, Worcester, MA; 4Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, MA; 5Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, MA
Background: Oncoplastic surgery (OPS) is a form of breast conservation surgery involving partial mastectomy followed by volume displacement or replacement surgery. As the field of OPS is growing, we sought to determine if there was a learning curve to this surgery.
Methods: A retrospective chart review was conducted of all patients who underwent OPS over a 6-year period with a single surgeon formally trained in both Plastic Surgery and Breast Oncology. Cumulative summation analysis (CUSUM) was performed on mean operative time to generate the learning curve and learning curve phases. Outcomes were compared between phases to determine significance.
Results: Mean operative time decreased across the 6-year period, generating 3 distinct learning curve phases: Learner phase (cases 1-23), Competence phase (24-73), and Mastery phase (>74). The positive margin rate was 10.9% and there was no difference in rates between phases (p=0.49). Overall complication rates, re-operation rates, and locoregional recurrence remained the same across all phases (p=0.16; p=0.65; p=0.41). The rate of nipple necrosis (superficial or complete) decreased between phases (p=0.02), while the remaining individual complications such as seroma, hematoma, wound dehiscence, fat necrosis, and infections remained the same (p=0.57; p=0.46; p=0.09; p=0.57; p=0.23 respectively).
Conclusion: As with many complex operations, there does appear to be a learning curve with OPS, as the operative time and the rates of nipple necrosis (superficial or complete) decreased with experience.
Back to 2022 Display Posters