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Unit of study_

SURG5040: Oncoplastic Breast Surgery Level 2

This unit of study concludes the specialist breast surgery curriculum. The focus is on breast reconstruction after mastectomy. It includes the full range of breast reconstruction techniques - implant based reconstruction, latissimus dorsi reconstruction and free flap tissue options – as well as lipofilling and nipple reconstruction techniques. Students will participate in multi-surgeon meeting case discussions with complex decision-making and management of complications.

Code SURG5040
Academic unit Surgery
Credit points 6
Prerequisites:
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SURG5037 and SURG5038 and SURG5039
Corequisites:
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None
Prohibitions:
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None
Assumed knowledge:
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This unit is designed as the forth and final part of a curriculum for contemporary breast surgery for Post Fellowship Trainees and assumes practical skills training is obtained on the BreastSurgANZ PFT Program (or equivalent). Applicants must have completed general or plastic surgical training and have a strong interest in breast surgery

At the completion of this unit, you should be able to:

  • LO1. understand the types of implants available and the mechanisms of determining size proportions and volume
  • LO2. understand the methods and limitations of determining size of implants for an individual patient
  • LO3. understand the range of available alternatives, and fundamentals of how lipodermal flaps, ADMs and other synthetic meshes may facilitate implant based reconstruction
  • LO4. understand the subtleties of selection of lipodermal flaps, ADMs or other meshes and the circumstances where each might be used
  • LO5. understand the individual features and origins of the different ADMs and meshes that are commonly available in ANZ
  • LO6. understand the surgical and multidisciplinary pressures that influence the options for immediate versus delayed breast reconstruction including the breadth and limitations of existing evidence in this area and the inability to conduct randomised clinical trials to improve the evidence base
  • LO7. understand the importance of appropriate audit of results - the quality of life impact of BR need to be recognised and the reasonable likelihood that those patients directed toward DBR will never have BR
  • LO8. understand the fundamentals of how to perform implant based reconstruction - discuss 1 and 2 stage implant reconstruction and benefits/limitations of each
  • LO9. discuss the benefits and issues with use of ADMs or not with 1 and 2 stage reconstruction
  • LO10. understand the immediate, short-term and long-term complications of implant based reconstruction and the management of these complications - you should be aware of strategies to avoid complications of implant BR - ASPS/ASCPS 14 point plan and you should be aware of the signs and patterns of complications including ALCL after implant based BR
  • LO11. understand the timing, principles of the surgery, common techniques available and complications associated with contralateral symmetry procedures after breast reconstruction
  • LO12. understand the anatomical basis for LD reconstruction - you should understand the fat distribution around the lat dorsi muscle and adjacent regions of fat zones and how they might be utilised in extended LD recon and you should understand the steps involved in an LD recon
  • LO13. understand the techniques and variations in technique for lipofilling - be aware of the evolving applications of lipofilling and understand the science of lipofilling - irrigation, local anaesthetic, centrifugation, take rates
  • LO14. understand the principles of pedicled and perforator flap breast reconstruction surgery, the range of options and selection of the appropriate option, long term outcomes and morbidity for available options and the planning for and execution of DIEP and TRAM breast reconstruction
  • LO15. understand plastic surgeons' preferences for breast surgeons' incisions and timing of reconstruction - opinions on DIEP/TRAM after chemo and chemo/RT
  • LO16. understand some of the subtleties of the less common options of autologous BR
  • LO17. understand case selection and timing across the range of reconstruction options
  • LO18. understand the emerging technologies of imaging BR and assessing skin flaps after SSM and NSM as well as measuring aesthetic outcomes from breast surgery and breast reconstruction - including from the patient’s perspective
  • LO19. understand quality of life measurement after breast surgery and breast reconstruction including PROMs.

Unit outlines

Unit outlines will be available 1 week before the first day of teaching for the relevant session.