The development of oncoplastic breast surgery in the UK

Abstract

: UK breast services have changed beyond recognition in 3 decades, improving standards of care and optimising results. Breast surgery has transformed from being a somewhat unattractive subspecialty activity of general surgeons to one of the most popular career options of young surgical trainees today. The variety of surgical techniques available has escalated enormously, with many new oncoplastic (OP) procedures now provided free of charge by the National Health Service. General surgeons subspecialising in breast surgery are now expected to acquire a range of reconstructive skills, while plastic surgeons subspecialising in breast reconstruction must demonstrate competence in the oncological principles and surgical aspects of breast cancer management. Inter-speciality training has been the key factor behind the acquisition of these new skills, in a programme backed up by new national audits, prospective cohort studies and guidelines. These activities are providing valuable data to inform the future configuration of OP surgery- which for many will inevitably result in a ‘stand alone’ specialty of OP Breast Surgery. In future, a range of developments will be needed to secure the viability and affordability of OP breast surgery. More objective decision-making tools are being developed to inform case and technique selection, together with standardised methods to measure clinical, aesthetic and patient-reported outcomes. The escalating costs of these procedures will need to be justified, backed up by the growing popularity and the oncological safety of OP conservation techniques that also avoid both the risks and the expense of implant-based and more major autologous procedures.