Using an ABS Educational Bursary to visit the Uppsala Breast Team in Sweden

I’m very grateful to the Association of Breast Surgery (ABS)  for awarding me the ABS Educational Bursary, which funded a highly rewarding 2½-week visit to Uppsala, Sweden. The visit included attendance at the Uppsala Breast Meeting  2025, followed by a two-week observership with the Uppsala Breast Unit. The experience helped to broaden my understanding of breast surgery and how breast cancer services are delivered in a different healthcare system.

The visit began with the Uppsala Breast Meeting where I was warmly welcomed by my host Andreas Karakatsanis – Associate Professor in Breast Surgery at Uppsala University and Deputy Editor for the European Journal for Surgical Oncology. This international conference brought together leading experts in breast surgery and oncology. 

One particularly memorable session at the meeting was a presentation by Professor Nicolo Rocco on the tripedicled nipple-sparing mastectomy. This technique combines oncological safety with improved cosmetic outcomes by maintaining the nipple-areolar complex’s blood supply through three separate pedicles – something that I will undoubtedly consider for my patients requiring skin reduction oncoplastic approaches. Another session that stood out explored tools for preoperative planning, including the use of the Longo formula to estimate breast volume. I gained a much clearer sense of how this simple anthropometric method can guide resection planning and improve postoperative symmetry - especially in therapeutic mammoplasty and oncoplastic surgery. In my training so far, objective breast volume estimation is often less formalised, and it was very interesting to consider a more scientific and mathematical approach.

The following two weeks were spent observing the Uppsala Breast Unit - a consultant-led service managing around 500 new breast cancer cases each year. Each week, consultants review approximately 60 new referrals, most of whom already have imaging arranged by their primary care doctors. Based on this initial vetting, patients are either discharged or invited for a face-to-face review. This triage model struck me as an efficient and pragmatic system, helping to reduce unnecessary clinic appointments while prioritising patients who need surgical or oncological input. I was also intrigued by the nurse-led theatre booking process: instead of surgeons scheduling their own lists, breast care nurse specialists coordinate theatre allocation in collaboration with operating staff. This system keeps theatre utilisation high while freeing consultants from some of the administrative burden.

Another notable difference from the UK is the Swedish surgical training pathway. There are no mandatory post-graduate exams before becoming a consultant, although rigorous peer review and governance processes are in place. I was also struck by the culture of work-life balance - with most hospital staff finishing early on Fridays. This practice was widely appreciated and seemed to contribute to excellent team morale.

With the team at Uppsala Breast Unit: Eirini Pantiora, Andreas Karakatsanis, Jaime Navia During the observership, I observed several complex oncoplastic operations. Of particular interest was a tripedicled therapeutic mammoplasty, and seeing this technique in practice deepened my understanding of its versatility. Another highlight was the frequent use of anterior and lateral intercostal artery perforator (AICAP and LICAP) flaps for breast-conserving surgery. The Uppsala team has refined these techniques into predictable, reproducible procedures, enabling breast conservation in patients who might otherwise not have been candidates. Watching these operations reinforced how critical detailed anatomical planning and technical precision are in modern breast surgery.

My time in Uppsala was an inspiring and formative experience. I returned with new surgical insights, a broader perspective on service delivery, and an appreciation for the thoughtful, patient-centred approach practiced by the Uppsala team. I’m deeply thankful to the ABS Educational Bursary and the hospitality of the team at the Uppsala Breast Unit for not only making this opportunity possible but making it such an enjoyable one. I have shared what I’ve learned within my unit and I would strongly encourage others interested in broadening their horizons to apply for this bursary and explore the excellent work being done in European breast centres.

Ronak Patel 
West Middlesex University Hospital

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