Oncoplastic Reconstructive Breast Surgeon (ORBS) Performance and Impact on Breast Reconstructions: Clinical Outcome, Learning Curve, and Patient Reported Aesthetic Results- An analysis of 451 Procedures

Oncoplastic and reconstructive breast surgeon (ORBS) aimed to incorporate aesthetics and plastic technique into breast cancer operations to balance the oncologic safety and cosmetic outcome, and also to promote breast reconstructions. The outcome of breast reconstruction performed by an ORBS was reported from a single institute. Among the 451 breast reconstructions performed by an ORBS, 75.8% were gel implant reconstructions, 3.3% were tissue expander, 16.9% were transverse rectus abdominal myocutaneous (TRAM) flap, 3.1% latissimus dorsi (LD) flap, and 0.9% LD flap + implant. The patients reported aesthetic evaluation showed that 53.9% responded excellent, 41.1% good, 4.4% fair, and 0.6% poor. In cumulative sum plot learning curve analysis, it took around 58 procedures for an ORBS to be familial with mastectomy followed by immediate gel implant reconstruction and to significantly decrease the operation time. In multivariate analysis, younger age, MRI, nipple sparing mastectomy, ORBS, and high-volume surgeon were factors related to breast reconstructions. Current study demonstrated that a breast surgeon after adequate training could become an ORBS and perform breast reconstructions with adequacy. Complimentary to traditional breast surgeon-to-plastic surgeon breast reconstruction pathways, ORBS could increase breast reconstructions rate, which remained low worldwide.