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Oncoplastic surgery in the treatment of breast cancer

Author Interview

Alberto Rancati

Plastic Surgeon, University of Buenos Aires, Buenos Aires, Argentina

1) Why did you specialize in plastic and reconstructive surgery?  I was born in Buenos Aires, Argentina, and since I was a kid, I dreamed of becoming a doctor. Being a teenager I was diagnosed with a melanoma on my arm and underwent surgery. This experience oriented me towards oncologic and reconstructive surgery and after my residence at the University of Buenos Aires, on general and oncologic surgery I made a fellowship programme of the UICC on melanoma and breast surgery at the Istituto Tumori, Milan, Italy under the direction of Dr. U.  Veronesi.
In Milan I was fortunate to work with Dr Maurizio Nava, of the Plastic Surgery Division, making reconstructions for all the patients of the National Cancer Institute and taking up a residency programme of Plastic and Reconstructive Surgery.
The possibility of working in surgical oncology and reconstructive surgery opened my mind to the possibility of giving to oncology patients the best possible treatment whilst paying attention to function and aesthetics as well. This gives you and the patient immediate results and gratification.

2) What is breast reconstruction? Breast reconstruction today is not only the rebuilding of the breast mound after removing breast tissue. Nowadays the breast surgeon and the plastic surgeon must have expertise in both breast oncology and plastic surgery techniques.
Oncoplastic Breast Surgery is a new specialty that combines the knowledge and criteria to give breast cancer patients the best result to complete treatment of their disease.

3) How do you decide which patients, after breast cancer surgery, are eligible for reconstructive surgery? Decisions about reconstructive surgery and the moment to perform it depend on different patient factors and doctors’ choices and preferences.
Factors involved in this decision are: overall health, staging, amount of tissue available, previous treatments such as radiotherapy, etc. Discussion with the patients is a must prior to mastectomy or conservative treatment.
Unfortunately a substantial number of general surgeons do not refer breast cancer patients who are eligible for a mastectomy or BCS to a breast reconstruction consultation at the time of surgical planning,

4) What are the risks, if any, associated with reconstructive surgery?  The decision to have breast reconstruction is extremely personal. The patient has to decide if the benefits will achieve the goals and if risks and potential complications are acceptable. Patients must be asked to sign consent forms to ensure they have a full understanding of the proposed procedure and risks.
Possible risks include bleeding, infection, poor healing and anesthesia. Flap surgery includes risk of partial or complete loss of the flap and loss of sensation both at the donor and reconstruction site, whilst the use of implants carries the risk of capsular contracture  or rupture.
No procedure is free of risk and some factors that may increase complication rates are obesity, smoking, bleeding disorders, malnutrition, chronic illnesses, prior radiation etc.
Sometimes the surgeon must decide between the best and the more adequate reconstructive procedure for each individual patient depending on these factors.

5) When is the best time to have breast reconstruction? The ideal scenario is a patient that has been recently diagnosed with a breast tumour and you have the possibility of treating it with conservative surgery, planning resection and reconstruction at the same time with enough breast tissue. Unfortunately not all the cases arrive for consultation at this stage.
However, all patients at any stage must be informed that there is always the possibility to reconstruct a breast.

6) You have just joined the Editorial Board of ecancermedicalscience, can you briefly explain why you joined the Board?  Joining the Editorial Board of ecancermedicalscience is not only an honour, but I also strongly believe in the vision that the journal has about sharing knowledge, research work and publications freely to doctors, and being supported by sponsorship and grants.
Surely this model will be imitated in the near future and our patients will be grateful for being the principal beneficiaries.

7)  With the launch of ecancerLatinoAmerica planned for later this year, how do you see the work of ecancer helping in Latin America? Latin America is a huge region with well trained and experienced doctors, but unfortunately the English language is not fully established, and publishing Latin American medical experience is not easy for Spanish speaking professionals. ecancer offers a unique opportunity  by translating accepted papers from Spanish to English for free, which opens  doors worldwide for Latin American work.

8) Finally, if you do get any spare time, what do you do to fill it?  I love sports, travelling and spending time with friends and family. I always try to combine work trips with fun and sports. My running shoes are the first thing I put in my luggage!

 

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Cancer Intelligence