Future direction of surgical training and services in Sri Lanka

Future directions of breast surgery in Sri Lanka Breast surgery has traditionally remained primarily within the scope of general surgeons and Oncological Surgeons in Sri Lanka. While this has ensured the availability of surgical treatment for diseases of the breast at all secondary and tertiary care hospitals, a relative lack of advancements and availability of newer techniques were observed in Sri Lanka, especially when compared with other branches of general surgery including gastrointestinal and hepatobiliary surgery. For instance, sentinel lymph node biopsy (SLNB) and wide local excision (WLE) for breast cancer are not offered on a regular basis in Sri Lanka at present [1], although SLNB and WLE have been the routine practice and included as the standard of care in most guidelines for over two decades [2, 3]. Many factors are known to have contributed to this situation including lack of training, heavy workload, lack of availability of mammography and other advanced imaging and lack of pathology services for intraoperative assessment of sentinel lymph nodes [4].