About the Program

The University of Iowa Multidisciplinary Breast Fellowship was started in 2008 and was approved by the Society of Surgical Oncology (SSO) in 2013. We were reaccredited for 5 years in 2016. Our fellows are successful in academic surgery, as leaders of community breast centers, and as private-practice breast surgeons.

Mission

We are committed to preparing our fellows for their chosen career path, tailoring their experience accordingly.

Clinical Experience and Rotations

Breast surgery team at work

Clinical Experience

  • Complex patients
  • Ultrasound experience
  • Radioactive seed localization
  • Intraoperative radiation therapy
  • Skin and nipple sparing mastectomy
  • Oncoplastic surgery
  • Lymphedema surgery

Clinical Rotations

Breast Imaging 4 weeks
Pathology 1 weeks + weekly pathology slide review
Medical Oncology/Radiation Oncology 4 weeks
Plastic Surgery 4 weeks
Breast Surgery 36 weeks

Breast Surgery Rotation

Thirty-six weeks will be spent on rotation with the breast surgery group. While on the surgical service, the fellow will be responsible for pre and post-op care of breast surgery patients. The fellow will actively participate in the outpatient clinics, including the benign breast and genetic counseling clinics. A schedule will be created to ensure exposure to all of the breast surgeons. The fellow will learn to evaluate and manage benign and malignant breast conditions and become proficient in the use of common in-office procedures such as breast sonography, cyst aspiration, FNA, and percutaneous core needle biopsy.

Breast Imaging Rotation

Four weeks will be spent in the Radiology department, including experience with mammography, breast ultrasound, and breast MRI. This time will be spent understanding the techniques of diagnostic mammography, BI-RADS nomenclature, and identifying the characteristics of benign and malignant disease. Time will be spent with breast sonography and image-guided (u/s, stereotactic, and MRI) biopsy techniques. In addition, the fellow will complete the ACS or equivalent courses for basic and advanced breast ultrasound. 

Medical Oncology/Radiation Oncology Rotation

Four weeks will be spent on rotation in the medical oncology outpatient clinics focused in breast cancer and radition oncology. The fellow will understand the indications, contraindications, mechanism of action, and common toxicities of chemotherapy and hormonal therapies. The fellow should be able to assess the indications and contraindications for and complications of radiation therapy and describe the process of patient experiences undergoing radiation therapy. The fellow will receive a schedule of radiation oncology case conferences and is expected to attend those pertinent to breast cancer care.

Pathology Rotation

One week will be spent in the Pathology department evaluating benign and malignant breast specimens, in addition to a weekly review of pathology slides. The fellow will be exposed to the techniques of fine needle aspiration of breast masses, for marking and processing pathology specimens, immunohistochemical stains, cytology and tumor markers. In addition, the fellow will review pathology for cases presented to tumor with the breast pathologist weekly during the 36 weeks of surgery rotations.

Plastic Surgery Rotation

Four weeks will be spent on service with Plastic and Reconstructive Surgery. The fellow will attend clinics and understand the decision making process for various reconstruction procedures. The fellow will also participate in the onco-plastic techniques of breast conservation, breast augmentation and reduction, the use of tissue expanders, implants, and flap reconstruction. The fellow may also participate in breast reconstructive surgeries while on surgery rotations. 

Integrated Rotations

  • Genetic counseling
  • Lymphedema clinic
  • Psycho-oncology
  • Breast center administration
  • Clinical trials/research methodology
  • Community outreach
  • Patient support groups
  • Longitudinal patient program to ensure continuity of care

Didactics and Conferences

Didactics

Didactics

  • Monthly case-based journal club
  • Multidisciplinary lecture series

Conferences

  • M&M (Tuesdays at 6:30 a.m.)
  • Surgery Grand Rounds (Tuesdays at 7:15 a.m.)
  • Breast Tumor Board (Fridays at 1 p.m.)

Experiences Outside the Institution

  • SSO Fellows Institute
    • Registration sponsored by program
  • AsBrS meeting attendance
    • Travel and registration sponsored by program
  • Other meetings and conferences
    • Travel sponsored if presenting at meeting, subject to approval from PD

Research

Interdisciplinary Breast Surgery Fellowship group at poster session

Fellows receive mentorship in research and complete at least one project for presentation/publication during the year. University of Iowa Breast Molecular Epidemiology Resource (BMER) and the Iowa Cancer Registry are both valuable local research resources. The BMER is an institutional repository containing longitudinal clinical information, patient reported outcomes and banked tissue/plasma from patients with benign and malignant breast disease.

The Iowa Cancer registry is part of the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program and is managed by our collaborators in the UI College of Public Health. Interested fellows can also pursue additional basic science research training through an NIH T32 training grant supported position (additional time required).

University of Iowa participates in both investigator led and national cooperative breast oncology trials, giving fellows experience with managing and recruiting for clinical trials.

Selected Fellow Research

Sophia Fu

Management of Breast Cancer Risk in Patients with Atypia: Variability in a Single Academic Institution. Poster presentation at American Society of Breast Surgeons Annual Meeting, May 2018

Emily Albright

Quality of Life is Adversely Affected by the Diagnosis of Proliferative Breast Lesions. Poster presentation at 2017 American Association of Breast Surgeons Annual Meeting, oral presentation at the Carol Scott Conner Visiting Professor Resident Research Day, third place winner.

Nipple-Sparing Mastectomy is Not Associated with Delay of Adjuvant Treatment. Oral presentation at 2017 Society of Surgical OncologyAnnual Cancer Symposium. Published Ann Surg Oncol 2018 June; 25: 1928.

Poorly Differentiated Neuroendocrine Carcinoma of the Breast with Merkel Cell Features. Breast J. 2018 Jul;24(4):644-647.

Anjali Thawani

MRI in Invasive Lobular Carcinoma Improves Preoperative Tumor Size Determination but Increases Mastectomy Rate, poster presentation, 2016 American Society of Breast Surgeons Annual Meeting. Oral presentation: Annual Carol Scott Conner Visiting Professor Resident Research Day, third place winner.

Rachael Hayes

Sentinel lymph node (SLN) localization is highly successful after neoadjuvant chemotherapy (NCT) for breast cancer. Poster presentation at the 2015 San Antonio Breast Cancer Symposium.