From the Guidelines
A general surgeon should not operate on breast cancer cases alone, as modern breast cancer care typically involves a multidisciplinary approach with a team of specialized healthcare professionals, including medical oncologists, breast surgeons, radiation oncologists, breast radiologists, breast pathologists, and breast nurses, to ensure optimal outcomes and improve patient care. According to the most recent and highest quality study, breast cancer treatment should be carried out in specialized breast units/centres and provided by a multidisciplinary team specialized in breast cancer 1. This approach is also supported by other recent studies, which emphasize the importance of collaboration between breast surgeons and other specialists, such as plastic surgeons, to achieve optimal oncological and cosmetic outcomes 1.
Key Considerations
- The complexity of the case and local practice patterns may influence the decision to operate alone or as part of a multidisciplinary team.
- For early-stage breast cancer requiring lumpectomy or mastectomy, a general surgeon with appropriate training and experience in breast surgery may perform these procedures independently, but collaboration with other specialists is often preferred for more complex cases.
- The trend in breast cancer care has moved toward specialized training and certification in breast surgery, as outcomes can be improved with surgeons who regularly perform these procedures and stay current with evolving techniques.
Surgical Management
- Procedures such as lumpectomy with sentinel lymph node biopsy, modified radical mastectomy, or skin/nipple-sparing mastectomy, potentially followed by reconstruction, may be performed by a general surgeon with appropriate training and experience.
- However, immediate or delayed breast reconstruction should be offered to most women requiring mastectomy, and autologous tissue-based reconstructive options should be considered 1.
- The surgical management of breast cancer should prioritize both oncological and cosmetic outcomes, and breast surgeons should collaborate with reconstructive surgeons and/or have training in oncoplastic approaches 1.
From the Research
Surgical Considerations for Breast Cancer
- The decision to operate on a breast cancer case alone as a general surgeon is complex and depends on various factors, including the type and stage of cancer, patient's overall health, and the surgeon's expertise 2.
- Neoadjuvant therapy, which involves treating the cancer with medication before surgery, can increase the chances of successful surgery and improve patient outcomes 3, 4, 2, 5.
- Studies have shown that neoadjuvant therapy can reduce the size of the tumor, making it easier to remove, and can also increase the chances of breast-conserving surgery 2, 5.
- However, neoadjuvant therapy can also have risks and side effects, such as increased morbidity and mortality, and the decision to use it should be made on a case-by-case basis 4.
Role of the General Surgeon
- A general surgeon may not always be equipped to handle complex breast cancer cases alone, and may need to work in collaboration with other specialists, such as oncologists and radiologists 6.
- The general surgeon should be aware of the latest research and guidelines on breast cancer treatment, including the use of neoadjuvant therapy, and should be able to make informed decisions about when to operate and when to refer patients to other specialists 3, 4, 2, 5.
- In some cases, a general surgeon may need to prioritize surgical cases and make decisions about when to operate and when to delay surgery, taking into account factors such as the patient's overall health and the availability of resources 6.