Plastic and Reconstructive Surgery • March 2015 logical solution is to train breast surgeons to understand breast aesthetics, to understand not only the complexities of breast oncology but also the principles of tissue rearrangement and breast reconstruction. Sadly, it is uncommon that plastic surgeons become involved in adaptive mammaplasty operations, and in fact there is no loss of patient referrals to the plastic surgeon; rather, there is simply a gain to the patient. In summary, oncoplastic surgery is here to stay. Plastic surgeons should embrace this major step forward because it improves patient outcomes. There will always be a role for plastic surgeons that have an interest in breast reconstruction. There will always be cases that are best treated by a two-team approach. Plastic surgeons should look for opportunities to work collaboratively with their breast specialist colleagues, not against them; as you point out in your Editorial, plastic surgeons do not dictate breast cancer referral patterns. DOI: 10.1097/PRS.0000000000001059
James French, F.R.A.C.S. Elisabeth Elder, Ph.D., F.R.A.C.S. Pouri Moradi, F.R.A.C.S.(Plast.) Westmead Breast Cancer Institute Westmead, New South Wales, Australia Correspondence to Dr. French Westmead Breast Cancer Institute P.O. Box 143 Westmead, New South Wales 2112, Australia [email protected]
DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. REFERENCE 1. Nahabedian MY. “Plastic surgery”… beware. Plast Reconstr Surg. 2014;133:965–966.
Reply: “Plastic Surgery”… Beware Sir:
Thank you for your comments with regard to the Editorial entitled, “‘Plastic Surgery’ … Beware.”1 Your insights and experience are greatly appreciated. As in Australia, multidiciplinary breast centers have become common in the United States. I agree that the advancements in breast surgery have been beneficial to patients in terms of quality and convenience. I agree that oncoplastic breast surgery has improved patient outcomes and satisfaction and is here to stay. I agree that collaboration among surgeons, physicians, and members of the health care team will further enhance all of these positive attributes. I disagree that plastic surgeons foster the old silo mentality because of self-interest and turf protection. I disagree that only a plastic surgeon can repair a breast defect and I emphatically disagree that plastic
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surgeons feel it is acceptable to leave the majority of breast cancer patients with an aesthetically unappealing result. Most breast defects following lumpectomy are small and uncomplicated, and do not require closure by a plastic surgeon. However, larger breast defects following partial or total mastectomy are more complicated and should be repaired by a plastic surgeon. In their response, it is stated that the most logical solution is to train breast surgeons to better understand breast aesthetics and principles of tissue rearrangement and reconstruction. They also state that it is “sadly uncommon for plastic surgeons to become involved in adaptive mammaplasty operations.” I was very intrigued by this statement because the strict definition of adaptation is the process of change by which an organism or species becomes better suited to its environment. I agree that adaptation is necessary in our ever-changing health care milieu. That said, I wonder what driving forces are perpetuating the type of adaptation being promoted in this reply. Is it purely about what is best for the patient? Because if it is, why is it considered adaptive for plastic surgeons that have been performing advanced breast reconstruction for the past 30 years to step aside and allow a non–plastic surgeon to perform it. Why is it considered maladaptive for breast and plastic surgeons to operate sequentially in the setting of complex partial and total mastectomy to provide patients with the highest standards of quality and care? Plastic surgeons are specifically trained to repair and reconstruct soft-tissue defects and to appropriately manage any complication that may occur. The ability to perform a particular operation requires that one has the ability to manage any complication that may arise from that operation. In the reply, it is stated that there will always be a role for plastic surgeons interested in breast reconstruction. Does the new concept of adaptive mammaplasty redefine the role of the plastic surgeon to perform only microvascular breast reconstruction and to be “on-call” and assist the breast surgeon when needed? Perhaps this is the case in Australia and much of Europe, but in the United States, a healthy collaborative relationship between breast and plastic surgeons still exists, and patient outcomes and satisfaction scores are higher than ever. DOI: 10.1097/PRS.0000000000001081
Maurice Y. Nahabedian, M.D.
Department of Plastic Surgery Georgetown University 3800 Reservoir Road NW Washington, D.C., 20007 [email protected]
DISCLOSURE The author has no relevant conflicts to disclose with regard to this communication. REFERENCE 1. Nahabedian MY. “Plastic surgery” … beware. Plast Reconstr Surg. 2014;33:965–966.
James French, F.R.A.C.S. Elisabeth Elder, Ph.D., F.R.A.C.S. Pouri Moradi, F.R.A.C.S.(Plast.) Westmead Breast Cancer Institute Westmead, New South Wales, Australia Correspondence to Dr. French Westmead Breast Cancer Institute P.O. Box 143 Westmead, New South Wales 2112, Australia [email protected]
DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. REFERENCE 1. Nahabedian MY. “Plastic surgery”… beware. Plast Reconstr Surg. 2014;133:965–966.
Reply: “Plastic Surgery”… Beware Sir:
Thank you for your comments with regard to the Editorial entitled, “‘Plastic Surgery’ … Beware.”1 Your insights and experience are greatly appreciated. As in Australia, multidiciplinary breast centers have become common in the United States. I agree that the advancements in breast surgery have been beneficial to patients in terms of quality and convenience. I agree that oncoplastic breast surgery has improved patient outcomes and satisfaction and is here to stay. I agree that collaboration among surgeons, physicians, and members of the health care team will further enhance all of these positive attributes. I disagree that plastic surgeons foster the old silo mentality because of self-interest and turf protection. I disagree that only a plastic surgeon can repair a breast defect and I emphatically disagree that plastic
650e
surgeons feel it is acceptable to leave the majority of breast cancer patients with an aesthetically unappealing result. Most breast defects following lumpectomy are small and uncomplicated, and do not require closure by a plastic surgeon. However, larger breast defects following partial or total mastectomy are more complicated and should be repaired by a plastic surgeon. In their response, it is stated that the most logical solution is to train breast surgeons to better understand breast aesthetics and principles of tissue rearrangement and reconstruction. They also state that it is “sadly uncommon for plastic surgeons to become involved in adaptive mammaplasty operations.” I was very intrigued by this statement because the strict definition of adaptation is the process of change by which an organism or species becomes better suited to its environment. I agree that adaptation is necessary in our ever-changing health care milieu. That said, I wonder what driving forces are perpetuating the type of adaptation being promoted in this reply. Is it purely about what is best for the patient? Because if it is, why is it considered adaptive for plastic surgeons that have been performing advanced breast reconstruction for the past 30 years to step aside and allow a non–plastic surgeon to perform it. Why is it considered maladaptive for breast and plastic surgeons to operate sequentially in the setting of complex partial and total mastectomy to provide patients with the highest standards of quality and care? Plastic surgeons are specifically trained to repair and reconstruct soft-tissue defects and to appropriately manage any complication that may occur. The ability to perform a particular operation requires that one has the ability to manage any complication that may arise from that operation. In the reply, it is stated that there will always be a role for plastic surgeons interested in breast reconstruction. Does the new concept of adaptive mammaplasty redefine the role of the plastic surgeon to perform only microvascular breast reconstruction and to be “on-call” and assist the breast surgeon when needed? Perhaps this is the case in Australia and much of Europe, but in the United States, a healthy collaborative relationship between breast and plastic surgeons still exists, and patient outcomes and satisfaction scores are higher than ever. DOI: 10.1097/PRS.0000000000001081
Maurice Y. Nahabedian, M.D.
Department of Plastic Surgery Georgetown University 3800 Reservoir Road NW Washington, D.C., 20007 [email protected]
DISCLOSURE The author has no relevant conflicts to disclose with regard to this communication. REFERENCE 1. Nahabedian MY. “Plastic surgery” … beware. Plast Reconstr Surg. 2014;33:965–966.
