A new subspecialty is not required
The comments made by Professor Baum in his editorial for the journal
“Breast”, and which you report, calling for a "serious look at the
training needs of those who wish to specialise in the care of women with
breast cancer" are to be applauded(1). It is no accident that the word
"plastic" be included in the title of his putative subspecialty.
Reconstructive plastic surgeons have been successfully addressing and
progressing the technical challenge of post extirpative breast deformities
for many more than "the last fifteen years".
Recently developed level III training posts for both general and plastic
surgical trainees essentially to learn each other’s discipline are flawed
in concept and unpopular. Limiting and shortening training produces
surgeons with limited horizons and robs them of the experience required to
extricate patients from difficult oncological situations. Ability to
address all aspects of breast reconstruction, congenital as well as
oncologic, demands broad based training in the full range of implant-
related and soft tissue techniques, including microsurgical. This training
must encompass the aesthetic aspects of the discipline. Such training
already exists within reconstructive plastic surgery.
By their very nature, NHS plastic surgeons are all "oncoplastic".
Approximately 30% of a typical consultants' general workload is cancer or
cancer related. Many currently play an integral part in the
multidisciplinary management of breast cancer. Professor Baum is worried
by the response of his general surgical colleagues to his proposal. The
answer to his dilemma and to which he points, is that this is no longer a
general surgical disease.
That there is a supply and demand problem for this type of surgery merely
reflects the persistent chronic under-expansion of a reconstructive
specialty whose role is much misunderstood within the modern NHS, even by
our surgical colleagues. The constant innovation in reconstructive
techniques provided by plastic surgery is to the advantage of patients and
the broader NHS. There is no need for a new sub-specialty, merely
expansion of what already exists and co-operative practices.
1) Dobson, R. News Roundup. Subspecialty of Oncoplastic Breast
Surgery is needed to meet demand BMJ 2003;326:1165
Competing interests: No competing interests