There is a strong trend toward specialist training and fellowships in Australia [1]. It is evident that specialization, especially in Breast cancer surgery, influences short- and long-term oncological outcomes for patient [2]. Operative experience forms the cornerstone of training to develop surgical skills, however, it is thought that with the focus on specialist training, there will be a decrease in operative opportunities for general surgery trainees, and in turn, new fellows will begin with less experience [1]. It has been observed in the United States that despite the case volume increasing, there is a down trend of at least 17 % of breast surgery cases reported in resident logbooks [3,4].

Studies that evaluated resident involvement are conflicting and have mainly come from the USA where the resident involvement is different from that of Australia [5]. The papers have mainly used re-excision of margins as the clinical indicator of complications for breast cancer surgery, with few studies that look at peri-operative complications, that may require a return to theatre. The morbidity of a patient increases per unplanned return to theatre for a complication, as well as extending both the hospital stay and time to adjuvant treatment [6,7] The most common complications requiring reoperation include haematoma, seroma, skin necrosis and surgical site infection [7]. There is no current literature that reviews all complications across the different types of breast operations, nor compares the complication rate between consultants and trainees.

Across Australia specifically, general surgery trainees undergo five years of training - potentially with only 6-months in a dedicated breast surgery unit. For further specialisation, trainees can complete a 2-year dedicated breast surgery fellowship managed by Breast Surgery Australia and New Zealand (BreastSurgANZ). It is typically during this fellowship where advanced breast cancer surgical techniques are learnt, namely “oncoplastic breast surgery” (OPBS). OPBS describes oncological resection with reconstruction of the breast tissue to have an aesthetic outcome. Volume displacement and volume replacement are key techniques in oncoplastic breast surgery [8].

We have reviewed the experience at a high-volume breast surgery department and evaluated whether training in advanced oncoplastic techniques in breast surgery impacts patient morbidity. We propose that in a structured teaching environment, junior surgeons can independently perform OPBS without an increased rate of complications.