SHOULD GENERAL SURGEONS PERFORM SPECIALTY PROCEDURES - AN OUTCOME EXPERIENCE WITH REDUCTION MAMMAPLASTY

Recent health care reform proposals have emphasized the need for ''gen eralists'' over ''specialists.'' Particularly targeted are the ''surgi cal specialities.'' If much of this reform comes to pass, this may lea ve patients for whom the only surgical care may come from the general surgeon. In this setting, opportunities exist for the general surgeon to provide services that now are claimed by surgical specialists. This study reports the outcome experience of one general surgeon providing one such procedure, reduction mammoplasty, to a beneficiary populatio n. Over a 26 month period, 50 reduction mammoplasties were performed. An average of 1527 grams of breast tissue were removed from each patie nt. There were no episodes of nipple necrosis or other complications r equiring reoperation. At 1-26 months follow-up, all patients had relie f of presenting symptoms, 90 per cent of patients had normal nipple se nsation; all patients were satisfied with the results and would have t he operation again by the same surgeon. These results show that a moti vated and well-trained general surgeon can provide specialty surgical care to a potentially underserved population. General surgeons should be allowed to develop and practice the full range of skills they will need to take advantage of the opportunities that will be available to the surgical ''generalist.''