Should general surgeons perform specialty procedures? An outcome experience with reduction mammoplasty.

Recent health care reform proposals have emphasized the need for "generalists" over "specialists." Particularly targeted are the "surgical specialties." If much of this reform comes to pass, this may leave 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 population. Over a 26 month period, 50 reduction mammoplasties were performed. An average of 1527 grams of breast tissue were removed from each patient. There were no episodes of nipple necrosis or other complications requiring reoperation. At 1-26 months follow-up, all patients had relief of presenting symptoms, 90 per cent of patients had normal nipple sensation; all patients were satisfied with the results and would have the operation again by the same surgeon. These results show that a motivated 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."