Oncoplastic Attitudes Survey Question Title * 1. How long have you been a consultant? Breast Surgery Plastic Surgery 0-5 years 0-5 years Breast Surgery 0-5 years Plastic Surgery 6-10 years 6-10 years Breast Surgery 6-10 years Plastic Surgery 11-15 years 11-15 years Breast Surgery 11-15 years Plastic Surgery > 16 years > 16 years Breast Surgery > 16 years Plastic Surgery I have another role: (please specify) Question Title * 2. Do you have an effective oncoplastic MDT? Yes No Other (please specify) Question Title * 3. Please describe your experience of the following techniques. I perform I perform with a colleague I am familiar with, but do not perform I am not familiar with Therapeutic Mammaplasty Therapeutic Mammaplasty I perform Therapeutic Mammaplasty I perform with a colleague Therapeutic Mammaplasty I am familiar with, but do not perform Therapeutic Mammaplasty I am not familiar with Grisotti Flap Grisotti Flap I perform Grisotti Flap I perform with a colleague Grisotti Flap I am familiar with, but do not perform Grisotti Flap I am not familiar with Breast Reduction Breast Reduction I perform Breast Reduction I perform with a colleague Breast Reduction I am familiar with, but do not perform Breast Reduction I am not familiar with Mastopexy (Breast Lift) Mastopexy (Breast Lift) I perform Mastopexy (Breast Lift) I perform with a colleague Mastopexy (Breast Lift) I am familiar with, but do not perform Mastopexy (Breast Lift) I am not familiar with Fat transfer Fat transfer I perform Fat transfer I perform with a colleague Fat transfer I am familiar with, but do not perform Fat transfer I am not familiar with Latissimus dorsi Latissimus dorsi I perform Latissimus dorsi I perform with a colleague Latissimus dorsi I am familiar with, but do not perform Latissimus dorsi I am not familiar with Tissue Expander / implant Tissue Expander / implant I perform Tissue Expander / implant I perform with a colleague Tissue Expander / implant I am familiar with, but do not perform Tissue Expander / implant I am not familiar with Dermal sling Dermal sling I perform Dermal sling I perform with a colleague Dermal sling I am familiar with, but do not perform Dermal sling I am not familiar with ADM ADM I perform ADM I perform with a colleague ADM I am familiar with, but do not perform ADM I am not familiar with Free flap Free flap I perform Free flap I perform with a colleague Free flap I am familiar with, but do not perform Free flap I am not familiar with Question Title * 4. Approximately what percentage of cases in your unit are suitable for therapeutic mammoplasty and how many are performed. Has this changed with the COVID Pandemic? 0% <10% 11-25% 26-50% 51-75% >76% Don't Know Suitable Suitable 0% Suitable <10% Suitable 11-25% Suitable 26-50% Suitable 51-75% Suitable >76% Suitable Don't Know Performed pre COVID Performed pre COVID 0% Performed pre COVID <10% Performed pre COVID 11-25% Performed pre COVID 26-50% Performed pre COVID 51-75% Performed pre COVID >76% Performed pre COVID Don't Know Performed post COVID Performed post COVID 0% Performed post COVID <10% Performed post COVID 11-25% Performed post COVID 26-50% Performed post COVID 51-75% Performed post COVID >76% Performed post COVID Don't Know Comments - has your mastectomy rate changed with COVID? Question Title * 5. Do you think breast and plastic surgeons should work more closely together to increase the provision of breast conserving surgery including therapeutic mammaplasty (TM) and local flaps (eg ICAP)? Yes, this should be standard of care Yes, during the COVID 19 restrictions, until we can freely offer immediate reconstruction Yes ideally, but circumstances in our unit would make this impossible No plastic surgery input needed as we perform and have capacity for all TM and ICAP/ local flaps No Comment Question Title * 6. Do you have any reservations about oncoplastic surgery in general Yes, delay in cancer surgery due to need to coordinate with plastic surgeons Yes, oncoplastic surgery requires too much theatre time Yes adjuvant therapy may be delayed due to healing problems Yes, about the oncological safety of resection Yes, about how to proceed if margins are involved Yes, about the viability of breast parenchyma after transposition Yes, data does not support he use of this technique Yes, about operating on the contralateral 'normal' breast No, I think oncoplastic surgery should be available to all women Other reservation (please specify) Question Title * 7. If you have inadequate margins for DCIS after therapeutic mammoplasty, how do you proceed? I do not do therapeutic mammaplasty Offer radiotherapy Take down therapeutic mammoplasty and resect margins Offer mastectomy This situation has not arisen in my practice Don't know Other (please specify) Question Title * 8. If you offer oncoplastic surgery in your unit, who does the majority of ipsilateral surgery (therapeutic mammaplasty) and contralateral surgery (eg breast reduction/ mastopexy)? Ipsilateral surgery Contralateral surgery Plastic surgeon alone Plastic surgeon alone Ipsilateral surgery Plastic surgeon alone Contralateral surgery Plastic and general surgeon (combined) Plastic and general surgeon (combined) Ipsilateral surgery Plastic and general surgeon (combined) Contralateral surgery Plastic and general surgeon (independent) Plastic and general surgeon (independent) Ipsilateral surgery Plastic and general surgeon (independent) Contralateral surgery General surgeon with oncoplastic training General surgeon with oncoplastic training Ipsilateral surgery General surgeon with oncoplastic training Contralateral surgery General surgeon alone General surgeon alone Ipsilateral surgery General surgeon alone Contralateral surgery We do not offer oncoplastic surgery We do not offer oncoplastic surgery Ipsilateral surgery We do not offer oncoplastic surgery Contralateral surgery What changes have occurred with COVID 19? Question Title * 9. The Association of Breast surgery published a guide to good practice in oncoplastic surgery. Do you agree with their indications for therapeutic mammaplasty? Agree Disagree >20% breast resection >20% breast resection Agree >20% breast resection Disagree Inferior resection Inferior resection Agree Inferior resection Disagree Central resection Central resection Agree Central resection Disagree Medial resection Medial resection Agree Medial resection Disagree If axillary dissection required through WLE incision If axillary dissection required through WLE incision Agree If axillary dissection required through WLE incision Disagree Large breasted women Large breasted women Agree Large breasted women Disagree Question Title * 10. Fat transfer, the process of liposuction followed by injection of the processed fat, is being used to correct small defects following breast surgery. Do you think this is a good idea? (more than one answer can be given) Yes, the benefits outweigh the risks in a fully informed patient No, multiple procedures are required No, it doesn't work No, the stem cells in fat may promote cancer recurrence No, the microcalcification that may follow can make screening more difficult No, subsequent fat necrosis may require repeated biopsies Other (please specify) Question Title * 11. If there were more training opportunities for oncoplastic surgery, would you be interested? Yes No Comment Question Title * 12. What are the main positives in breast reconstruction that has resulted from the COVID 19 Pandemic in your department? Done