Scenario Analysis: This scenario presents a common challenge in oncoplastic surgery where the surgeon must balance the immediate need for effective tumor removal with the long-term aesthetic and functional outcomes for the patient. The choice of energy device and its application directly impacts tissue handling, hemostasis, and the potential for collateral damage, all of which are critical for successful reconstruction and minimizing complications. Professional judgment is required to select the most appropriate tool and technique based on the specific tumor characteristics, location, and the planned reconstructive strategy, while adhering to established safety protocols. Correct Approach Analysis: The best professional practice involves a meticulous pre-operative assessment of the tumor and surrounding tissues, coupled with a thorough understanding of the capabilities and limitations of available energy devices. This includes selecting an energy device that offers precise cutting and coagulation with minimal thermal spread, appropriate for the delicate nature of breast tissue and the need for oncologic clearance. The surgeon should then employ the device with controlled settings and technique, prioritizing oncologic margins while simultaneously preserving tissue viability for reconstruction. This approach aligns with the ethical imperative to provide the highest standard of care, minimizing patient harm and maximizing functional and aesthetic outcomes, as guided by professional surgical standards and best practice guidelines for oncologic resections and reconstructive breast surgery. Incorrect Approaches Analysis: Using an energy device with excessive thermal spread, such as electrocautery set at high power for extensive tissue coagulation, risks significant collateral thermal damage to surrounding healthy breast tissue. This can compromise the viability of tissue needed for reconstruction, increase the risk of post-operative complications like fat necrosis or wound dehiscence, and potentially impact the oncologic margins if the thermal damage extends beyond the intended resection area. This approach fails to uphold the principle of beneficence and non-maleficence by unnecessarily increasing patient risk and compromising reconstructive potential. Employing an energy device that is not adequately suited for the specific tissue type or surgical task, for instance, using a blunt dissection technique with an energy device that is primarily designed for cutting, can lead to inefficient hemostasis and uncontrolled bleeding. This necessitates prolonged operative time, increases the risk of hematoma formation, and can compromise the surgeon’s ability to achieve clear oncologic margins due to poor visualization. This represents a failure in professional competence and adherence to best surgical practices. Opting for an energy device solely based on surgeon preference or perceived speed, without considering its impact on tissue quality for reconstruction or the potential for thermal injury, demonstrates a disregard for patient-specific needs and optimal surgical outcomes. This can lead to suboptimal aesthetic results and increased morbidity, violating the ethical obligation to prioritize the patient’s well-being and the quality of care. Professional Reasoning: Professionals should adopt a systematic decision-making process that begins with a comprehensive patient and disease assessment. This includes understanding the oncologic goals, the planned reconstructive technique, and the specific characteristics of the tumor. Next, they must evaluate the available instrumentation and energy devices, considering their technical specifications, known efficacy, and safety profiles in the context of breast surgery. The selection should be guided by evidence-based practice and a commitment to minimizing patient harm while maximizing functional and aesthetic outcomes. Finally, continuous intraoperative assessment and adaptation of technique are crucial to ensure that the chosen approach remains the most appropriate for the evolving surgical field.

The efficiency study reveals a need to streamline the fellowship exit examination process. This scenario is professionally challenging because it requires balancing the imperative to maintain rigorous standards for patient safety and the quality of oncoplastic surgery with the need for an efficient and accessible evaluation process for fellows. Misjudging the purpose and eligibility criteria could lead to either unqualified surgeons entering practice or highly competent surgeons facing undue barriers. The correct approach involves a thorough review of the examination’s established purpose and the specific eligibility requirements as defined by the governing bodies of North American oncoplastic surgery fellowships. This includes understanding that the examination is designed to assess a fellow’s mastery of advanced oncoplastic techniques, clinical judgment in breast cancer management, and adherence to ethical surgical practice. Eligibility should be strictly tied to the successful completion of an accredited fellowship program, demonstrated proficiency in core competencies, and adherence to any specific procedural requirements outlined by the examination board. This ensures that only candidates who have met the defined standards of training and competence are permitted to take the exam, thereby upholding the integrity of the specialty and protecting public health. An incorrect approach would be to broaden eligibility to include surgeons who have not completed a formal accredited fellowship, even if they have extensive experience. This fails to acknowledge the structured, comprehensive training and mentorship inherent in accredited fellowship programs, which are specifically designed to prepare surgeons for the complexities of oncoplastic surgery. Such an approach risks allowing individuals to bypass essential training components, potentially compromising patient care and devaluing the fellowship credential. Another incorrect approach would be to interpret the examination’s purpose solely as a procedural hurdle, focusing on administrative completion rather than substantive competency assessment. This might lead to a reduction in the rigor of the evaluation or a relaxation of eligibility criteria to increase pass rates. Such a focus undermines the examination’s role in safeguarding patient safety and ensuring that fellows possess the necessary skills and knowledge to practice oncoplastic surgery at a high standard. A further incorrect approach would be to prioritize the convenience of the examination administrators over the needs of the fellows or the standards of the specialty. This could manifest as arbitrary changes to examination content or format without proper consultation or validation, or the imposition of overly burdensome administrative requirements that detract from the core purpose of assessing surgical competence. Professionals should approach this situation by first consulting the official documentation and guidelines from the relevant oncoplastic surgery professional organizations and accreditation bodies. They should then engage in a collaborative process involving fellowship directors, examination board members, and potentially recent fellows to understand the current challenges and propose evidence-based solutions that align with the established purpose and eligibility criteria of the examination. The decision-making process should prioritize patient safety, the integrity of the specialty, and the fair and equitable assessment of all eligible candidates.

This scenario is professionally challenging because it requires balancing the immediate need for efficient patient care with the long-term imperative of continuous quality improvement and patient safety, all within a regulated healthcare environment. The pressure to reduce wait times can conflict with the thoroughness needed for effective process evaluation and implementation of changes. Careful judgment is required to ensure that efficiency gains do not compromise the quality of oncoplastic surgery services or patient outcomes. The best professional approach involves a systematic, data-driven evaluation of the current patient pathway to identify bottlenecks and areas for improvement, followed by the development and piloting of targeted interventions with clear success metrics. This approach prioritizes patient safety and evidence-based practice. It aligns with the ethical obligation to provide high-quality care and the regulatory expectation for healthcare providers to continuously monitor and improve their services. By engaging all relevant stakeholders, including surgeons, nursing staff, administrative personnel, and crucially, patients, this method ensures that proposed changes are practical, effective, and address the root causes of delays, rather than superficial symptoms. The use of pilot testing allows for refinement before full implementation, minimizing disruption and risk. An approach that focuses solely on increasing surgical throughput without a comprehensive understanding of the entire patient journey is ethically problematic. It risks overlooking critical pre-operative or post-operative care steps that might be contributing to delays or negatively impacting patient outcomes. This could lead to increased readmission rates or suboptimal recovery, violating the duty of care. Implementing changes based on anecdotal evidence or the loudest voices within the department, without objective data collection and analysis, is professionally unsound. This can lead to the adoption of ineffective or even detrimental practices, failing to address the actual issues and potentially creating new problems. It also disregards the importance of evidence-based decision-making, a cornerstone of modern healthcare practice. Relying solely on external benchmarks without internal process analysis is also insufficient. While benchmarks provide valuable context, they do not account for the unique operational realities and patient demographics of a specific department. Implementing changes based on external data alone without understanding the internal workflow can lead to misapplication of solutions and wasted resources. Professionals should employ a structured decision-making process that begins with clearly defining the problem and its impact. This should be followed by data collection and analysis to understand the root causes. Stakeholder engagement is crucial at every stage to gather diverse perspectives and ensure buy-in. Interventions should be designed based on evidence, piloted, and then rigorously evaluated before widespread adoption. Continuous monitoring and feedback loops are essential for sustained improvement.

The control framework reveals a scenario demanding astute judgment in managing a complex post-operative complication following oncoplastic breast surgery. This situation is professionally challenging due to the inherent risks associated with major surgery, the potential for significant patient morbidity, the need for rapid and accurate diagnosis, and the ethical imperative to provide timely and appropriate care while maintaining patient trust and informed consent. The surgeon must balance immediate clinical needs with long-term patient outcomes and the principles of good medical practice. The best approach involves immediate, transparent communication with the patient regarding the suspected complication, its potential causes, and the proposed diagnostic and management plan. This includes obtaining informed consent for any necessary investigations or interventions. Prompt consultation with relevant specialists, such as radiologists or infectious disease experts, is crucial for accurate diagnosis and collaborative management. This approach aligns with ethical principles of patient autonomy, beneficence, and non-maleficence, as well as professional guidelines emphasizing clear communication and evidence-based practice. It prioritizes the patient’s well-being and their right to be fully informed and involved in their care. An incorrect approach would be to delay informing the patient about the suspected complication, hoping it resolves spontaneously or downplaying its significance. This failure violates the principle of patient autonomy and the ethical duty to be truthful and transparent. It erodes trust and can lead to patient anxiety and a sense of being disempowered in their own healthcare journey. Furthermore, delaying diagnosis and intervention can exacerbate the complication, leading to poorer outcomes and potentially increasing the risk of litigation. Another unacceptable approach would be to proceed with aggressive surgical intervention without first thoroughly investigating the suspected complication or consulting with appropriate specialists. This demonstrates a lack of due diligence and a failure to adhere to best practices in diagnostic workup. It risks unnecessary surgical morbidity for the patient and may not address the root cause of the problem, leading to suboptimal outcomes. This approach disregards the principle of proportionality in medical interventions. Finally, an approach that involves delegating the primary responsibility for managing the complication to junior staff without adequate supervision or clear direction is also professionally unsound. While teamwork is essential, the ultimate responsibility for patient care rests with the senior clinician. This failure to provide adequate oversight can lead to diagnostic errors, delayed treatment, and compromised patient safety, violating the duty of care. Professional reasoning in such situations requires a systematic approach: first, recognize and acknowledge the potential complication. Second, gather all relevant clinical information. Third, communicate openly and honestly with the patient, explaining the situation and proposed plan. Fourth, consult with colleagues and specialists as needed. Fifth, develop and implement a clear, evidence-based management plan, continuously reassessing the patient’s progress. Finally, document all assessments, decisions, and communications thoroughly.

This scenario presents a significant professional challenge due to the inherent unpredictability of trauma, the critical need for rapid and effective intervention, and the complex ethical considerations surrounding patient autonomy and resource allocation in a high-stakes environment. The surgeon must balance immediate life-saving measures with the long-term implications for the patient’s oncoplastic reconstruction, all while adhering to established protocols and ensuring patient safety. Careful judgment is required to navigate the competing demands of acute resuscitation and definitive surgical planning. The best approach involves prioritizing immediate life-saving interventions and stabilization according to established Advanced Trauma Life Support (ATLS) principles. This includes a rapid primary survey (Airway, Breathing, Circulation, Disability, Exposure) to identify and manage immediate threats to life. Once the patient is hemodynamically stable and critical injuries are addressed, a secondary survey can be performed, which may include a more detailed assessment of the oncoplastic site and preliminary planning for subsequent reconstruction. This approach is correct because it aligns with the fundamental ethical and regulatory imperative to preserve life and prevent further harm. Adherence to ATLS protocols is a widely accepted standard of care in trauma management, ensuring a systematic and evidence-based approach to resuscitation. Ethically, this prioritizes the patient’s immediate survival, which is a prerequisite for any future oncoplastic procedures. An incorrect approach would be to immediately focus on the oncoplastic defect before ensuring the patient’s hemodynamic stability and addressing any life-threatening injuries. This is professionally unacceptable because it violates the core principles of trauma care, potentially leading to irreversible harm or death by neglecting immediate threats. Ethically, it prioritizes a reconstructive goal over the patient’s fundamental right to life and safety. Another incorrect approach would be to delay definitive surgical management of critical injuries to obtain extensive pre-operative imaging and consultations for the oncoplastic reconstruction. This is professionally unacceptable as it introduces unnecessary delays in life-saving interventions, increasing the risk of complications and mortality. Ethically, it demonstrates a failure to uphold the duty of care by not acting with the necessary urgency in a critical situation. A further incorrect approach would be to proceed with oncoplastic reconstruction without adequate resuscitation and stabilization, assuming the patient will tolerate the procedure. This is professionally unacceptable because it disregards the physiological stress of trauma and surgery, potentially leading to catastrophic outcomes. Ethically, it represents a reckless disregard for patient well-being and a failure to adhere to established safety protocols. Professionals should employ a structured decision-making process that begins with a rapid assessment of the patient’s overall condition, prioritizing ABCs (Airway, Breathing, Circulation). This should be followed by a systematic evaluation for life-threatening injuries. Once immediate threats are managed, the focus can shift to secondary assessment and more definitive management, including considerations for oncoplastic reconstruction, always guided by established protocols and ethical principles of beneficence, non-maleficence, and patient autonomy.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between patient autonomy, the need for comprehensive informed consent, and the potential for a trainee’s learning curve to impact patient care. Navigating this requires a delicate balance to ensure patient safety and ethical practice while fostering the development of future oncoplastic surgeons. Careful judgment is required to uphold the highest standards of patient care and professional integrity. Correct Approach Analysis: The best professional practice involves the attending surgeon directly obtaining informed consent from the patient, clearly outlining the role of the fellow trainee in the procedure. This approach ensures the patient fully understands who will be performing which aspects of the surgery, the level of supervision, and the potential implications for their care. This is ethically mandated by principles of patient autonomy and the requirement for transparent communication. Regulatory frameworks, such as those governing medical practice and professional conduct, emphasize the attending physician’s ultimate responsibility for patient care and the necessity of obtaining valid informed consent, which includes disclosing the involvement of trainees and the nature of their participation. Incorrect Approaches Analysis: One incorrect approach involves the attending surgeon delegating the entire informed consent process to the fellow trainee without direct oversight or explicit disclosure to the patient about the trainee’s role. This fails to uphold the attending surgeon’s responsibility for patient care and can lead to a breach of informed consent if the trainee does not fully grasp the nuances of the procedure or potential complications, or if they do not adequately convey this information to the patient. Ethically, this undermines patient autonomy by not ensuring the patient has received complete and accurate information from the most qualified individual. Another incorrect approach is to proceed with the surgery with the fellow trainee performing significant portions without prior explicit consent from the patient regarding the trainee’s involvement, even if the attending is present. This constitutes a violation of informed consent and patient trust. It bypasses the ethical and regulatory requirement to inform patients about who is performing their surgery and the level of their involvement, regardless of supervision. A further incorrect approach is to obtain consent for the procedure generally but fail to specifically mention the trainee’s role in performing key surgical steps. While the attending surgeon remains ultimately responsible, the patient has a right to know the specific individuals undertaking their care and the extent of their involvement, especially when it deviates from standard practice where the attending performs the majority of the procedure. This lack of specificity can be seen as a failure to provide truly informed consent, potentially leading to patient dissatisfaction and ethical breaches. Professional Reasoning: Professionals should adopt a decision-making framework that prioritizes patient safety and autonomy. This involves a commitment to transparency, clear communication, and adherence to ethical principles and regulatory guidelines. When trainees are involved in patient care, the attending physician must ensure that informed consent is obtained comprehensively, detailing the trainee’s role and the level of supervision. This process should be iterative, allowing for patient questions and ensuring their understanding before proceeding with any medical intervention. The attending’s ultimate responsibility for patient outcomes necessitates their active involvement in all critical aspects of care, including the informed consent process.

The efficiency study reveals a need to optimize operative planning for oncoplastic breast surgery, particularly concerning structured approaches to risk mitigation. This scenario is professionally challenging because it requires balancing the immediate surgical goals of tumor removal and aesthetic reconstruction with the long-term well-being of the patient, all within a framework of established best practices and ethical considerations. The inherent complexity of oncoplastic surgery, involving both oncological principles and reconstructive techniques, necessitates a meticulous and systematic approach to planning to minimize potential complications and ensure optimal outcomes. The best approach involves a comprehensive pre-operative assessment that includes detailed patient history, physical examination, imaging review, and a thorough discussion of risks, benefits, and alternatives with the patient. This approach prioritizes patient safety and informed consent, aligning with the ethical principles of beneficence, non-maleficence, and autonomy. Specifically, a structured operative plan should incorporate a multidisciplinary team review (including surgeons, pathologists, radiologists, and oncologists) to confirm the diagnosis, stage the disease accurately, and determine the optimal surgical strategy. This plan should explicitly outline the oncological margins, the reconstructive technique, potential complications, and contingency plans. The patient’s understanding and agreement to this plan, including realistic expectations regarding aesthetic and functional outcomes, are paramount. This aligns with regulatory requirements for informed consent and professional guidelines emphasizing patient-centered care. An approach that relies solely on the surgeon’s experience without formal documentation or multidisciplinary input fails to adequately address potential oversights and can lead to suboptimal patient care. This bypasses the established ethical duty to ensure all reasonable steps are taken to achieve the best possible outcome and mitigate foreseeable risks. Furthermore, it may not meet regulatory expectations for thorough documentation and evidence-based practice. Another unacceptable approach is to proceed with a reconstruction technique that has not been fully vetted against the oncological requirements or the patient’s specific anatomy and tissue quality. This can result in compromised oncological clearance or poor aesthetic results, potentially necessitating further interventions and causing patient distress. It neglects the fundamental principle of tailoring the surgical plan to the individual patient’s needs and the specific disease characteristics. Finally, an approach that prioritizes speed of surgery over thorough planning and risk assessment is professionally unsound. While efficiency is desirable, it should never come at the expense of patient safety or the quality of care. Rushing the planning phase can lead to errors in judgment, missed critical details, and an increased likelihood of complications, violating the core tenets of medical ethics and professional responsibility. Professionals should adopt a decision-making framework that emphasizes a systematic, evidence-based, and patient-centered approach. This involves a continuous cycle of assessment, planning, execution, and review, with a strong emphasis on communication and collaboration among the healthcare team and with the patient. Structured checklists, pre-operative simulation, and post-operative debriefing can further enhance this process.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between achieving optimal oncological clearance and preserving breast cosmesis, especially when dealing with a palpable lesion close to the nipple-areolar complex. The surgeon must balance the immediate need for effective cancer removal with the long-term functional and aesthetic outcomes for the patient, all while adhering to established surgical standards and patient-centered care principles. The proximity of the tumor to critical structures necessitates meticulous planning and execution to avoid compromising either oncological safety or aesthetic results. Correct Approach Analysis: The best professional practice involves a multidisciplinary discussion and shared decision-making process with the patient. This approach prioritizes a thorough pre-operative assessment, including advanced imaging and potentially intraoperative margin assessment techniques, to precisely delineate the tumor boundaries. It then involves a detailed discussion with the patient about the risks and benefits of various surgical options, including the likelihood of achieving clear margins with breast-conserving surgery versus the necessity of a mastectomy, and the subsequent reconstructive options. This aligns with ethical principles of patient autonomy and informed consent, ensuring the patient’s values and preferences are central to the treatment plan. Regulatory frameworks emphasize patient-centered care and the importance of shared decision-making in complex surgical scenarios. Incorrect Approaches Analysis: Proceeding with a standard lumpectomy without further pre-operative assessment or detailed patient discussion risks inadequate oncological clearance if the tumor is larger or more diffuse than initially apparent, leading to positive margins and the need for re-excision or mastectomy. This fails to uphold the principle of achieving oncological safety. Opting immediately for a mastectomy without exploring all viable breast-conserving options, even if technically feasible, may disregard the patient’s desire for breast preservation and potentially lead to unnecessary psychological distress and a more complex reconstructive journey. This approach may not align with the principle of least invasive effective treatment. Performing a lumpectomy with the intention of “wait and see” regarding margins, without employing techniques for intraoperative assessment or a clear plan for adjuvant therapy based on definitive pathology, represents a failure to adhere to established oncological standards and patient safety protocols. Professional Reasoning: Professionals should employ a systematic decision-making framework that begins with a comprehensive assessment of the clinical and radiological findings. This should be followed by an open and honest discussion with the patient, exploring their goals, concerns, and understanding of the disease and treatment options. The surgeon should then integrate their clinical expertise with the patient’s preferences to formulate a personalized treatment plan, which may involve further diagnostic steps or consultation with other specialists. The decision-making process must be iterative, allowing for adjustments based on new information or evolving patient needs, always prioritizing both oncological efficacy and patient well-being.

Scenario Analysis: This scenario is professionally challenging because it involves a critical incident with potential patient harm, requiring a delicate balance between immediate patient care, thorough investigation, and maintaining team morale. The pressure to identify root causes without assigning blame prematurely, while also ensuring patient safety and adherence to institutional protocols, demands careful judgment and a structured approach. Correct Approach Analysis: The best professional practice involves convening a multidisciplinary morbidity and mortality (M&M) review committee. This committee, composed of surgeons, anesthesiologists, nurses, and potentially patient safety officers, would systematically review the case. The focus would be on identifying systemic issues, deviations from best practices, and contributing human factors, such as communication breakdowns, fatigue, or equipment malfunctions, rather than solely on individual performance. This approach aligns with the principles of a just culture, which encourages reporting of errors and near misses without fear of punitive action, thereby fostering a learning environment. Regulatory frameworks and professional guidelines emphasize the importance of such reviews for continuous quality improvement and patient safety. Incorrect Approaches Analysis: Focusing solely on the attending surgeon’s technical skill during the M&M review, without considering the broader context of the surgical environment, communication, or team dynamics, fails to address potential systemic vulnerabilities. This approach risks unfairly blaming an individual and overlooks opportunities for broader process improvements, potentially violating principles of a just culture and hindering effective quality assurance. Immediately implementing punitive measures against the surgical team members involved before a thorough investigation is completed is premature and counterproductive. This action undermines trust, discourages future reporting of errors or concerns, and is contrary to the principles of a just culture that prioritize learning and system improvement over blame. It also bypasses established institutional protocols for incident review. Limiting the M&M review to a brief discussion during a regular departmental meeting without a structured agenda or dedicated time for in-depth analysis would be insufficient. This superficial approach would likely fail to uncover the root causes of the complication, miss opportunities for learning, and neglect the systematic review required for effective quality assurance and patient safety enhancement. Professional Reasoning: Professionals should approach such situations by first ensuring immediate patient safety and then initiating a formal, structured M&M review process. This process should be guided by principles of a just culture, emphasizing learning and system improvement. Decision-making should involve a multidisciplinary team, a systematic investigation of all contributing factors (including human factors and system issues), and a focus on actionable recommendations for preventing future adverse events.

Scenario Analysis: This scenario presents a professionally challenging situation due to the inherent risks associated with oncoplastic surgery, specifically the potential for unexpected intraoperative findings that deviate from preoperative imaging. The surgeon must balance the immediate need to address the identified pathology with the long-term oncological and aesthetic outcomes for the patient. This requires a deep understanding of surgical anatomy, the physiological response to surgical intervention, and the principles of perioperative care, all while adhering to ethical obligations of informed consent and patient safety. The challenge lies in making rapid, informed decisions under pressure, ensuring that any deviation from the planned procedure is justified and documented. Correct Approach Analysis: The best professional practice involves a systematic approach that prioritizes patient safety and oncological clearance. This begins with a thorough intraoperative assessment, including palpation and visual inspection of the tumor margins and surrounding tissues. If the intraoperative findings suggest a greater extent of disease than anticipated, or if the tumor is not clearly demarcated, the surgeon should proceed with a wider margin excision, guided by intraoperative frozen section analysis if available and indicated. This approach ensures that the primary oncological goal of complete tumor removal is met. Following this, the surgeon should then proceed with the reconstructive phase of the oncoplastic procedure, adapting the reconstruction to the altered tissue defect. This decision-making process is ethically grounded in the principle of beneficence, ensuring the patient receives the best possible oncological outcome, and is supported by professional guidelines that emphasize the primacy of cancer control in surgical planning. Incorrect Approaches Analysis: Proceeding with the original, narrower excision despite intraoperative findings of potentially wider disease spread would be professionally unacceptable. This approach fails to adequately address the oncological risk, potentially leaving residual tumor cells and jeopardizing the patient’s long-term prognosis. It also violates the principle of non-maleficence by exposing the patient to the risk of recurrence due to incomplete resection. Abandoning the reconstruction entirely and closing the defect without addressing the oncological concern is also unacceptable. This would leave the patient with an unresected tumor, directly contradicting the purpose of the surgery and failing to uphold the duty of care. Delaying the decision to widen the excision until a later date, without immediate intraoperative assessment and intervention, is also professionally unsound. This introduces unnecessary delays in definitive oncological treatment and increases the risk of tumor progression or metastasis. Professional Reasoning: Professionals facing such a scenario should employ a decision-making framework that integrates anatomical knowledge, physiological understanding, and ethical principles. This framework involves: 1) Re-evaluating preoperative data in light of intraoperative findings. 2) Performing a meticulous intraoperative assessment of the tumor and surrounding structures. 3) Consulting with colleagues or intraoperative pathology if available and necessary. 4) Prioritizing oncological clearance while considering reconstructive feasibility. 5) Communicating any significant deviations from the plan to the patient or their designated representative as soon as practically possible, especially if it impacts the scope of the surgery or subsequent recovery. The ultimate decision must be guided by the principle of providing the safest and most effective treatment for the patient’s specific condition.