EDUCATIONAL PROGRAM

Two years educational program
in search of excellence in breast surgery.

  • Basic Sciences on breast disease
  • How to build a breast unit
  • Breast cancer research: How, who and when
  • Imaging Techniques for breast:
    Ultrasound. Mammogram. MR imaging. Breast PET Scan for diagnosis and follow-up.
    Interventional radiology: stereotactic breast biopsy, imaging-guided needle breast biopsy, ultrasound guided breast biopsy

Benign breast disease:

  • Nipple discharge and the role of ductoscopy
  • Inflammatory and related lesions: mastitis, foreign body reactions, recurrent subareolar abscess, mammary duct ectasia, fat necrosis
  • Fibrocystic changes: cysts, adenosis, metaplasia, epithelial hyperplasia, ductal lesions, lobular lesions, columnar cell lesions, radial scar and complex sclerosing lesion, intraductal papilloma and papillomatosis
  • Benign tumours: fibroadenoma, lipoma, adenoma, hamartoma, granular cell tumour

Management of malignant breast disease:

  • Diagnosis of breast cancer: Clinical examination, Laboratory investigations, Pathological diagnosis, Clinical staging and risk assessment and Prognostic factors
  • Treatment: Adjuvant systemic therapy, Primary chemotherapy (neoadjuvant chemotherapy) in locally advanced breast cancer and Follow-up
  • Management of metastatic disease: Staging of metastatic or recurrent breast cancer, Local recurrence, Systemic dissemination and Chemotherapy regimens for recurrent or metastatic breast cancer
  • Pathological handling of breast cancer excision specimens: fine needle aspiration biopsy and core needle biopsy, mastectomy specimen, mammographically-directed excisions, frozen section diagnosis, surgical pathology report of breast cancer specimens.
  • Radiotherapy guidelines for breast cancer: Radiotherapy for ductal carcinoma in situ, Criteria for breast conserving therapy, Post-mastectomy radiotherapy and Radiotherapy after pre-operative systemic therapy.
  • Management of special situations in breast cancer: Breast cancer in elderly women, in very young woman and in male.
  • Surgical anatomy of the breast
  • Breast conserving surgery:
    Tumorectomy. Quadrantectomy
  • Techniques of mastectomy:
    Simple mastectomy. Skin sparing. Nipple sparing
  • The axilla
    Current management. Sentinel node biopsy. Lynmphedema prevention
  • Partial breast reconstruction
  • Oncoplastic surgery techniques for breast conserving surgery
    Local perforator flaps: TDAP, ICAP, LICAP, SEAP… Autologous platelet gel prosthesis to fill tumorectomy defect. Fat grafting
  • Locally advanced breast cancer
    Oncological surgery management. Chest wall reconstruction
  • Management of breast cancer sequelae
    Shoulder damage, chronic pain. Radiation induced angiosarcoma. Psychological impact
  • Surgical guidelines for breast cancer
    Surgical approach to the axilla including sentinel lymph node biopsy. Surgical technique
  • Psychosocial issues in breast cancer
  • Sentinel node biopsy approach in internal mammary chain
  • Skin sparing mastectomy
  • Axillary lymphnode clearence
  • Implant reconstruction with ADM
  • Lower limb and pelvis:
    PAP. Lumbar perforator flap (LPF). Inferior gluteal artery perforator flap (IGAP). Superior gluteal artery perforator flap (SGAP). Gracilis (ATMG)
  • Trunk:
    Internal mammary fascio-cutaneous flaps. Intercostal flaps. Scapulo-dorsal flaps: latissimus dorsi, thoracodorsal artery perforator flap (TDAP), scapular flap, parascapular flap and chimeric flaps. Abdominal wall flaps: musculo-cutaneous rectus abdominis flap (TRAM), deep inferior epigastric perforator flap (DIEP) and Taylor, superficial inferior epigastric artery flap (SIEA). Free lymph node transfer
  • Breast Glandular flaps
  • Flap dissections: Latissimus dorsi, DIEP, SGAP, TUG, PAP
  • Basic management of experimental animal, microscope and instrumentation
  • End-to-end suture of the carotid artery and femoral artery
  • End-to-end suture of the jugular vein and femoral vein
  • Aorto-iliac end-to-end suture
  • End-to-side suture between femoral artery and vein
  • Jugular vein graft to carotid artery
  • “In situ” groin flap
  • Distant groin flap to the neck
  • Perforator flap anatomy
  • Preoperative planning of perforator flaps
  • Dissection technique of perforator flaps
  • Dissection technique in lymphatic surgery
  • Fundamentals of microsurgical techniques
  • Perforator Flaps in Breast Reconstruction
  • “Hands on” Dissection Session:
    Gluteal and dorsal perforator flaps. Free style perforator flaps. Transferring the flaps to the recipient vessels. Super microsurgical flaps. Lymphatic channel dissection. Lymph node transfer
  • ICT lymphography assessment on pigs

CONCEPTS AND BASICS IN BREAST RECONSTRUCTION:

  • Essential concepts in breast reconstruction:
    The psychological impact. Provision of information. How to assess and provide options. Influence of chemotherapy
  • How to setup a breast reconstruction unit
  • Immediate vs delayed breast reconstruction. Indications and contraindications
  • High risk breast cancer:
    Genetic breast cancer. Identifying women at high risk. Prophylactic mastectomy: subcutaneous mastectomy, skin sparing mastectomy, nipple sparing mastectomy, nipple-areola sparing mastectomy
  • Radiotherapy in breast reconstruction:
    Timing post radiotherapy. The impact of ADM. Post autologous reconstruction
  • Breast reconstruction in special situations:
    Obese patients. Skinny patients. Elderly patients

IMPLANT BASED BREAST RECONSTRUCTION:

  • Primary implant reconstruction:
    How to mark for an SSM
    Two-stage breast reconstruction utilizing tissue expander and implant
    Matrices: biologic vs synthetic, indications, contraindications
  • Delayed breast reconstruction with Implants:
    Two-stage breast reconstruction utilizing tissue expander and implant
    The role of Becker expander
  • Composite implant breast reconstruction
  • Nipple-areola reconstruction
  • Contralateral breast symmetrisation
  • Management of complications:
    Capsular Contracture. Infection and extrusion in implants based reconstruction. Skin flap necrosis. Asymmetry. Rippling. Rotation. Malposition
  • Litigation in breast surgery
  • Perforator flaps in breast reconstruction:
    DIEAP, SIEA , SGAP, IGAP, LAP, PAP, extended TDAP
  • How to get out of trouble intraoperative
  • How to prepare and plan: Assesment of smoking, diabetes…, prior surgery to harvest site
  • Breast reconstruction with implant vs autologous tissue reconstruction
  • Imaging in perforator flaps

Immediate and delayed reconstruction:

  • Oncoplastic breast surgery: glandular and perforator flap techniques
  • Breast reconstruction: DIEP flap, SIEA flap, TAP flap, SGAP flap, IGAP flap, fat grafting, transverse myocutaneous gracilis flap (TMG), extended TAP, PAP, lumbar perforator flap, latissimus Dorsi
  • Partial breast reconstruction: oncoplastic and perforator flap techniques
  • Autologus flap reconstruction with fat grafting
  • Thoracic wall reconstruction

Postoperative management

  • Flap monitoring.
  • How to manage complications

Managing breast tumors

  • Oncological management in breast tumors.
  • Reconstructive planning in breast tumors.
  • Aesthetic concepts of the breast:
    Definitions. How to measure the breast. Imaging techniques (photography, 3D imaging, etc). How to conduct a consultation for an aesthetic breast procedure
  • Breast Augmentation:
    Implants: types, incisions, plane, complications
    Secondary surgery. Fat grafting as adjuvant. Imaging diagnostic techniques for follow-up
  • Breast Reduction Mammoplasty:
    Pre-operatory study
    Techniques: superior pedicle, inferior pedicle, lateral pedicle, round-block, free nipple graft technique…
    Liposuction “alone”
  • Congenital Breast deformities:
    Poland syndrome. Tuberous breast. Chest wall deformities: pectus excavatum, pectus carinatum
  • Mastopexy:
    Techniques. With implants. With fat grafting
  • Gynecomastia
  • Lymphedema diagnosis
  • Lymphedema conservative treatment
  • Managrment of lymphedema complications
  • Anatomy and physiology of the lymphatic system
  • Assessment and surgical treatment of lymphedema
  • Vascularised lymphatic node transfer
  • Lympho-venous anastomosis
  • Combined surgical treatment for lymhedema
  • Lymphangiogenesis and the role of growth factors in lymphedema

Small groups of students will have the opportunity to observe live microsurgical techniques in lymphedema treatment. Live webcast surgery will be shown and interactive participation will be facilitated.

The program includes a practical training module with feedback from facilitators. During this period, students will be involved in clinical cases focused on breast surgery and assist in surgery, following preoperative and postoperative clinics. They will present cases to the other students and faculty to clarify doubts and evaluate the surgery.

From 6 weeks to 12 months before the end of the second year.

  • Joint review of the microsurgical technique
  • Presentation and discussion of complex clinical cases
  • Resolution of immediate and delayed post-surgical complications involving the flaps
  • Optimization of technique tailored to each student

Preparation of a comprehensive written research report is an essential part of a valid research experience, and the student should be aware of this requirement at the outset of the project.

Interim reports may also be required. Sufficient time should be allowed for satisfactory completion of reports, taking into account that initial drafts should be supervised and corrected by your tutor.