I have always enjoyed taking part in microsurgical breast reconstruction and was always fascinated by free flaps, especially when I was doing my Oncoplastic Fellowship in Essex. When I started my consultant post in Aberdeen some of my Plastic Surgery Colleagues noted this and encouraged me to learn more and take a more active part in the microsurgical procedures.
I came across the European School of Reconstructive Microsurgery; which through the Universitat Autònoma de Barcelona offers different courses, one of which is the Diploma in Breast Microsurgical Reconstructive techniques. The modules run at different cities across Europe, with units across the globe taking part as clinical immersion centers for people wanting to obtain a Master’s degree. The driving force behind this is Prof Jaume Masia from St. Pau Hospital in Barcelona along Prof Jian Farhadi from St Thomas’s in London and with them they have a fantastic faculty that support the different modules at the different centers to include the UK, Spain, France, Italy, Finland and Romania.
For my Diploma, I attended 5 modules, in Barcelona, Alicante and Strasbourg and met wonderful people from Asia, the Middle East, Central and South America, and Europe. Most came from a Plastics background but many were breast surgeons either with a general surgery or gynecology backgrounds. Some of the modules were practical and skills based in the lab, while others where teaching blocks to show different techniques through lectures, live operating and tutorials on the different aspects of breast cancer, reconstruction and microsurgery.
The first module was in St Pau’s Hospital in Barcelona, which was the small animal dissection module. For three days, we dissected and practiced microvascular anastomosis on live rats. Dissecting the femoral and carotid vessels is not easy on rats, and suturing them back together is challenging. The second Module was the clinical training module in autologous breast microsurgical reconstruction which was a combination of lectures and live operating sessions. On these three days, we watched a DIEP, SGAP and TDaP performed live with commentary and interactive lectures while the operations were performed. It was a pleasure seeing Jaume Masia, Koenraad Van Landuyt, Jian Farhadi and Moustapha Hamdi operating live. After that we went to Alicante for the Cadaveric Dissection module, where we were shown how to raise the different flaps.
The super-microsurgery and lymphatic surgery module was held in Barcelona. Though mainly delivered as lectures, there was a live operating session on lymph node transfer and lymphatico-venous anastomosis. This was followed by the Barcelona Breast Meeting, which is an international meeting with speakers from across the world from both breast and plastics that addressed the different advances and controversies in breast reconstruction. The theme of the meeting was complications, so we saw the good, the bad and the ugly and how experts dealt with these complications. The last module was the live animal module, at the IRCAD in Strasbourg. This center is the best in Europe and one of the best in the world. We had nearly 20 operating tables with anaesthetized pigs on which we dissected DIEPs, SGAP and TDAPs.
After each module, we had an assessment which was either technical skills that you need to be able to perform, or an MCQ exam. The Master’s students must present complex cases and complications from their units and must sit a final oral exam.
Overall I have thoroughly enjoyed every aspect of this Diploma, and what made it special is the excellent faculty that they have. All experienced well known surgeons, down to earth and keen to teach. I will always remember sharing the taxi with Prof Masia in Alicante and having a very nice chat with him on the way from the airport and the side talks with Prof Hamdi. Now I feel more confident in my knowledge of free flap surgery and will be developing my skills with the help of my plastic surgery colleagues so that I will be a part of the microsurgical team in the hospital.
Aberdeen Royal Infirmary