Cavalcante Francisco Pimentel, de Oliveira Vilmar Marques, Ziegelmann Patrícia Klarmann, Brenelli Fabrício Palermo, Paulinelli Régis Resende, Hassan Augusto Tufi, Novita Guilherme Garcia, Millen Eduardo Camargo, Zerwes Felipe Pereira, Mattar André, Antonini Marcelo, Frasson Antônio Luiz, de Andrade Urban Cícero, Pessoa Eduardo Carvalho, Ruiz Carlos Alberto, Biazus Jorge Villanova, Freitas-Junior Ruffo, da Costa Vieira Rene Aloisio
Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio Mesquita Filho (UNESP), São Paulo, SP, Brazil.
Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.
Ann Surg Oncol. 2025 May 6. doi: 10.1245/s10434-025-17435-1.
Historically, breast reconstruction was performed by plastic surgeons. The Brazilian Society of Mastology (SBM) implemented initiatives to improve breast surgeons' training in oncoplastic techniques; however, the current proportion of surgeons performing these techniques remained unknown. This study aimed to determine the proportion of Brazilian breast surgeons performing oncoplastic surgery, their previous training, the complexity of procedures performed, and factors influencing adoption of techniques.
In this survey, a structured questionnaire was sent to all SBM-affiliated breast surgeons between July and December 2023. Outcome proportions were estimated using binomial distribution. Adjusted proportion ratios (aPR) were calculated using robust Poisson regression.
A 60.2% valid response rate was achieved (n = 1059/1759). Almost half of the respondents performed oncoplastic surgery, with most being young (< 40 years) (aPR: 1.66; 1.31-1.10; p < 0.001), male (aPR: 1.39; 1.22-1.59; p < 0.001), southern residents (aPR: 1.39; 1.18-1.63; p < 0.001), with a specialist degree in breast disease (aPR: 1.19; 1.00-1.42; p < 0.004), primarily trained in general surgery (aPR: 1.32; 1.16-1.51; p < 0.001) and secondarily in breast surgery (aPR: 1.41; 1.08-1.85; p = 0.01), and performing > 100 surgeries/year (aPR: 1.72; 1.49-1.99; p < 0.001). The techniques most commonly mastered were simple displacement (88.7%), therapeutic mammoplasty or contralateral symmetrization (96.4%), reconstruction with implants or tissue expanders (93.6%), extreme oncoplasty (81%), skin- and nipple-sparing (99%) or skin-reducing mastectomy (84.2%), and thoracoabdominal flaps (71.7%).
A high proportion of Brazilian mastologists perform oncoplastic surgery. These findings provide key insights to further enhance training and improve outcomes.
从历史上看，乳房重建手术由整形外科医生进行。巴西乳腺病学会（SBM）采取了多项举措来提高乳腺外科医生在肿瘤整形技术方面的培训水平；然而，目前实施这些技术的外科医生比例仍不明确。本研究旨在确定实施肿瘤整形手术的巴西乳腺外科医生比例、他们之前的培训情况、所实施手术的复杂性以及影响技术采用的因素。
在本次调查中，于2023年7月至12月向所有隶属于SBM的乳腺外科医生发送了一份结构化问卷。使用二项分布估计结果比例。采用稳健泊松回归计算调整后的比例比（aPR）。
有效回复率达到60.2%（n = 1059/1759）。几乎一半的受访者实施肿瘤整形手术，其中大多数为年轻（<40岁）（aPR：1.66；1.31 - 1.10；p < 0.001）、男性（aPR：1.39；1.22 - 1.59；p < 0.001）、居住在南部地区（aPR：1.39；1.18 - 1.63；p < 0.001）、拥有乳腺疾病专业学位（aPR：1.19；1.00 - 1.42；p < 0.004），主要接受普通外科培训（aPR：1.32；1.16 - 1.51；p < 0.001），其次接受乳腺外科培训（aPR：1.41；1.08 - 1.85；p = 0.01），且每年实施手术>100例（aPR：1.72；1. – ；p < 0.001）。最常掌握的技术包括简单移位（88.7%）、治疗性乳房成形术或对侧对称化（96.4%）、植入物或组织扩张器重建（93.6%）、极端肿瘤整形术（81%）、保留皮肤和乳头的乳房切除术（99%）或皮肤缩减乳房切除术（84.2%）以及胸腹皮瓣（71.7%）。
很大比例的巴西乳腺病医生实施肿瘤整形手术。这些发现为进一步加强培训和改善治疗效果提供了关键见解。
