Do any breast fellowships train fellows on reconstruction techniques? It seems a pedicled TRAM should be reasonable for a general surgeon to learn in the span of a year as they operate both in the abdomen and breast. How about breast implants/augmentation? Is a full blown plastics fellowship the only way to learn these skills? Do any unofficial/unpaid fellowships exist?
Just by way of an update since a year ago when this thread was first opened:
this year 16 residents did not match into an SSO approved Breast fellowship, so despite predictions last year that perhaps we had reached the saturation point of programs vs applicants, this was obviously not the case.
The SSO requires 1 month of Plastic Surgery "experience" for its approved breast surgery fellowships. How this is accomplished is up to the individual program. Remember that a breast fellowship includes much more than just OR time - so you really don't have a "year" to learn your techniques.
In general, you will not get enough operative exposure through these fellowships to be able to do pedicled flaps comfortably enough on your own. There are Aesthetic Breast fellowships, some of which are open to general surgery trained residents and these can be found through the American Society of Plastic and Reconstructive Surgeons. Most however require prior PRS training.
Besides the limited exposure to reconstructive techniques during a breast fellowship, there are other considerations to be made:
- the oncologic and plastic surgeons have different priorities. The oncologic surgeon's goal is to provide the best cancer surgery and that means removing as much breast tissue as possible, leaving fairly thin flaps for the plastic surgeon. The plastic surgeon would prefer thicker flaps as they give better implant/muscle coverage and are more natural feeling and appearing. You will find that many breast surgeons object to the idea of doing the reconstruction themselves because of these conflicts. You do not want to compromise your cancer operation for aesthetic values.
- it is unlikely that you would be trained well enough to realistically compete with plastic surgeons in the arena of breast reconstruction or even be given OR priviledges to do so. I agree that, procedurally, breast augmentation with implants is pretty easy...the artistry is probably the most difficult task. And even after doing several lat dorsi flaps with some of our plastics guys, I believe that technically I could do those as well. But there is just no substitute for adequate training.
Therefore, I think most would recommend either doing plastics or looking into an aesthetic breast fellowship for additional training.
Finally, there are unapproved fellowships for breast out there - some "we" know about (these tend to be large universities who just haven't gotten their paperwork into the SSO yet) and there may be others, private practice based or smaller community programs which aren't well known. I am not aware of any unpaid fellowships (and am not sure why anyone would be interested in one).
