• Andreas Karakatsanis, Malin Sund, Nicola Rocco, Jill R Dietz, Ashutosh Kothari, Mustapha Hamdi, Yazan A Masannat, and Peter A Barry.
• Department for Surgical Sciences, Uppsala University, Uppsala, Sweden.
• Br J Surg. 2023 Jul 17; 110 (8): 966972966-972.

BackgroundVolume replacement using chest wall perforator flaps (CWPFs) is a promising technique to reduce mastectomy rates without sacrificing function or aesthetics. Owing to limited availability of the technique, only a minority of patients currently have access to CWPF procedures.MethodsAn international web-based survey was disseminated through social media, dedicated webpages, and national and international societies for breast surgery. The survey explored surgeons' attitudes towards CWPFs and their perceived training needs.ResultsOf 619 respondents, 88.4 per cent agreed that CWPF surgery was desirable, with one-third offering it and performing a median of 10 (i.q.r. 5-15) procedures annually. They were more likely to be senior (OR 1.35, 95 per cent c.i. 1.18 to 1.55; P < 0.001), with formal oncoplastic training (OR 4.80, 3.09 to 7.48; P < 0.001), and working in larger units (OR 1.18, 1.03 to 1.35; P = 0.018) with a free-flap (OR 1.62, 1.06 to 2.48; P = 0.025) or CWPF (OR 3.02, 1.87 to 4.89; P < 0.001) service available. In cluster and latent class analysis, none showed high cohesion with performance of CWPF surgery.ConclusionThere is a discrepancy between perceived importance and availability of CWPF surgery, indicating that optimal training is needed.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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