This was my final placement of the International Fellowship in Oncoplastic Reconstructive and Breast Surgery, which was established in memory of Mr Guidubaldo Querci Della Rovere in 2012. Mr Querci Della Rovere, or ‘Uccio’ to his friends, was a Consultant Breast Surgeon at the Royal Marsden Hospital in Sutton and forged links with Professor Maurizio Nava due to their common desire to advance the management of patients with breast disease.
I spent six months working within the plastic surgery department at the Institute and was able to compare and contrast the health systems, patient populations and chosen techniques. The Italian health system provides free public health care and the country has the 10th highest life expectancy with an average of over 80 years. Healthcare is provided by a mixed public-private system, but waiting times can be many months and patients often opt to pay for certain aspects of their treatment. The Fondazione IRCCS Istituto Nazionale dei Tumori was established in 1928 and is a 428 bed hospital in the north-east area of the city of Milan. It is dedicated to clinical excellence and actively participates in clinical research trials. Professor Maurizio Nava was appointed as chief of the plastic and reconstructive department after dual specialisation in general and plastic reconstructive surgery. He is actively involved in research, education and teaching, and established a charitable fund to help promote awareness of breast cancer treatment and reconstruction techniques. The departmental structure of healthcare in Italy differs to the UK, as the unit is led by a chief who supervises specialists and residents within the team. There are 7 specialists within the plastic and reconstructive surgery unit and they work closely with the breast, sarcoma, head and neck, cardiothoracic and colorectal teams to provide reconstructive options, often to patients with challenging clinical presentations.
Professor Nava and his team have published on techniques which have been adopted world-wide and I was able to witness the use of various different implants, meshes and ADMs as part of one or two-stage breast reconstruction procedures. The use of symmetrisation surgery is high and familiarity with different pedicles and auto-mastopexy techniques will be invaluable in my future career. Skin-sparing and skin-reducing techniques are routinely used and this allowed me to witness a high volume of cases. The use of subpectoral expanders is chosen by many women, as they desire a fuller, more youthful breast following their breast cancer diagnosis and treatment. Professor Nava and his team are currently performing a randomised controlled clinical trial to evaluate one versus two-stage based reconstruction and the results may have a significant impact on breast reconstruction in the future.
My weekly timetable was varied and flexible. I was able to spend time in theatre with Professor Nava and his colleagues and be involved in the pre-operative planning and decision-making. My grasp of the Italian language is limited, but non-verbal communication skills allowed me to understand many of the patients’ concerns and requests, permitting engagement with the assessment processes. The Italian doctors were keen to improve their English and I was happy to assist them with this, even though it was to the detriment to my Italian! I was the first International Fellow to spend time at the Institute, but the centre has been attracting surgeons from across the globe for many years. I valued the opportunity to meet doctors from other areas in Italy and further afield such as Brazil, Chile, Mexico, and Thailand. The healthcare systems in these countries vary greatly and have led me to re-evaluate the service provided by the NHS in a more positive light.
My previous experience of Italy had been confined to fleeting visits as I attended conferences with my latest poster presentation in tow. Milan is often overlooked by tourists who pass from Rome and Naples through Florence to Venice, but the city has a vibrant atmosphere and culture, with the local economy generating 20% of Italy’s total GDP. The fellowship gave me the opportunity to visit many places in the northern part of the country, which are easily accessible using the efficient train system. The cities of Mantova, Pavia, and Bergamo are wonderful examples of Italian architecture and traditions. The opportunity to visit Naples with a Neapolitan family left me feeling like I had survived a weekend with the Sopranos!
I would like to thank Professor Nava and his colleagues, especially Alessandra and Novella, at the Institute for their kindness, support and understanding during my time there. The experience has greatly enhanced my knowledge, which will help me greatly in my future career.