Transforming Breast Surgery Education in Italy: Nationwide Survey Findings

Overview

A national survey of 126 Italian breast surgeons and residents revealed significant variability and perceived inadequacies in breast surgery training. Most participants highlighted the lack of standardized, competency-based pathways and the need for formal recognition of breast surgery as a subspecialty.

Background

Breast cancer is the most common cancer among women globally and in Italy, where over 53,000 new cases are estimated annually. Optimal breast cancer outcomes depend on specialized multidisciplinary care, yet in Italy, breast surgery is not formally recognized as a distinct subspecialty. Training is inconsistent, with general surgeons and gynecologists performing breast surgery without standardized curricula or mandatory breast-specific procedural targets. Internationally, formal fellowships and certifications exist, but Italy lacks national certification or dedicated examinations.

Data Highlights

Key Findings

• 31.9% response rate with 126 participants: 77% consultants and 23% residents.
• Nearly half of respondents work in medium-volume breast units; only 19.8% in low-volume centers.
• Majority (45.2%) have over 10 years of clinical experience in breast surgery.
• Significant variability exists in breast surgery training exposure during residency, with no mandatory breast-specific procedural targets nationally.
• Breast reconstruction and advanced oncoplastic procedures are predominantly performed by plastic surgeons, limiting hands-on experience for general surgery trainees.
• There is strong consensus on the need for a structured, competency-based national training pathway and formal recognition of breast surgery as a subspecialty in Italy.

Clinical Implications

The findings underscore the urgent need to standardize breast surgery training in Italy to improve oncologic and aesthetic outcomes for breast cancer patients. Implementing a formal subspecialty certification and incorporating dedicated breast surgery curricula during residency could enhance surgeon competence and multidisciplinary collaboration. This would align Italy with international standards and potentially improve patient survival and quality of life.

Conclusion

This nationwide survey highlights critical gaps and variability in breast surgery education in Italy, advocating for structured reforms to establish breast surgery as a recognized subspecialty with standardized training pathways. Such changes are essential to optimize breast cancer care and outcomes nationally.

References

1. Italian National Cancer Institute 2024 -- Breast Cancer Incidence and Survivorship in Italy
2. European Breast Surgical Oncology (BRESO) Curriculum 2023 -- Standardizing Breast Surgery Training
3. ANISC 2025 -- Nationwide Survey on Breast Surgery Training in Italy