Breast cancer surgery has changed: more surgeons are trained in oncoplastic techniques and more centres are seeking accreditation as breast units. The underlying question is whether so many seals of approval translate into better care. A study published in Breast Care compares, from the responses of surgeons in several countries, the surgical outcomes reported by oncoplastic and non-oncoplastic specialists, and by accredited versus non-accredited breast centres.
What was already known
Oncoplastic surgery combines oncological tumour removal with plastic and reconstructive techniques. Depending on the training system it may be performed by a single oncoplastic surgeon (one-team approach) or by two surgeons (two-team approach). The one-team model offers organisational advantages but has raised concerns about oncological outcomes. A broad comparison between types of surgeon and between accredited and non-accredited centres was missing.
What this work adds
The authors designed a two-part questionnaire with 9 general and 16 specific questions on surgical treatment carried out between 2018 and 2022. It asked about the rate of R1 resections (involved margins), re-operations due to complications, immediate reconstructions and the number of mastectomies. A total of 173 members of four major international professional societies, together representing more than a thousand surgeons, responded, and 125 questionnaires were finally analysed. These are self-reported data, not an audit of clinical records.
Main results
Most respondents were general surgery specialists and performed oncoplastic procedures in accredited breast centres. A large share said they needed further training. Oncoplastic surgeons reported the highest caseload. Non-oncoplastic surgeons reported the lowest mastectomy rates, while those working exclusively in breast surgery reported the highest rates of immediate reconstruction. R1 resection rates varied between surgeons and between centres, and complications were more frequent in non-accredited centres.
What it means
What matters is not who operates more, but where the problems cluster: centre accreditation appears associated with fewer reported complications, and the variability in surgical margins suggests that outcomes depend as much on the organisation around the team as on the team itself. The authors highlight two concrete tools: intraoperative frozen section analysis and better training.
A view from the breast unit
The study’s indicators (R1 resections, re-operations, immediate reconstruction, mastectomies) are the same ones used to assess quality in a breast unit. Measuring and comparing them between centres is more useful than any single seal of approval.
Reference: Wimmer K, Gordon K, Emmanuel K, Steger G, Gnant M, Weber WP, et al. Surgical Outcome Parameters in Breast Cancer: A Survey Comparing Oncoplastic and Non-Oncoplastic Surgeons as well as Certified with Non-Certified Breast Health Centers. Breast Care (Basel), 2026. https://doi.org/10.1159/000548657
