News

Breast Cancer Interspecialty Training and Education Project 
We are pleased to announce that we have received an extension on the grant for Breast Cancer Interspeciality Training and education project for £50k for 6 months, and we will expand the project into the northern territories in Nigeria, with the cascading courses on the latest updates in breast cancer and the multidisciplinary team.

These courses have been previously run in Nigeria and Ghana, in Abuja, Accra, Ibadan, Zaria and Kumasi.
 

Paa Hoyte Williams (left) consultant plastic surgeon at Komfo anokye hospital in Kumasi with Kwame Darko (right), consultant plastic surgeon from Accra ghana at the THET learning event. 
 

(L-R) Prof Abdulrasheed Ibrahim, Consultant Plastic Surgeon , ABU Zaria, Prof Sufiyan M. Babale, Consultant Community Health Physician, ABU Zaria, Adenike Badiora, GHWP grant manager, Onyes Juliet Amaka - Nurse National Hospital Abuja, Dr. Cephas Batta, General Surgeon National Hospital, Abuja, at the Nigerian THET learning event. 

Webinars

There are no webinars lined up for January, but if you have missed any of the webinars from last year you can watch them on our website including some fantastic webinars for revision of key topics within Plastic Surgery!

 

Education

Free online surgical skills course!

Interested in developing your basic surgical skills?

Mr Hamid Tehrani, Consultant Plastic Surgeon, is collaborating with BFIRST to offer 3 different online surgical skills courses. They are fully virtual and can be completed at your own pace and will be most useful for medical students and junior surgical trainees.

If you are interested in enrolling yourself or junior colleagues in this course for free please contact BFIRST on info@bfirst.org.uk

 

Projects 

Guyana

The BFIRST team, consisting of Mr Maniram Ragbir, Mr Naveen Cavale, Dr Rajeev Venugopal, Dr Stephen Romany and Dr Sarah Lonie, travelled to Georgetown, Guyana in January 2025 and were based at the Georgetown Public Hospital Corporation (GPHC). Our goals before embarking on this trip, were to nurture relationships with surgeons in the Caribbean, introduce microsurgery techniques to the surgical teams in Guyana, teach and train local surgeons and help to establish a breast reconstruction service in the country.
 

Dr Shilindra Rajkumar, plastic surgeon from GPHC, worked with his team to coordinate this visit with patients for surgery across four days. The cases planned to cover involved microsurgery for breast and chest wall reconstruction, utilising latissimus dorsi flaps, pedicled TRAM flaps, and free DIEP flaps
The first full day of the visit presented with some challenges in that the microscope very kindly donated by Newcastle upon Tyne NHS Trust did not arrive in the morning as planned. Instead, the local ophthalmology microscope was used, with the local hospital team building an additional platform for the microscope within a matter of hours, to ensure that it could be positioned high enough above the operating table intraoperatively.
 

Otherwise, this day was spent meeting the members of local team, ensuring equipment brought from the UK was prepared for the cases, meeting the patients, reviewing their scans and finalising the surgical plans. The project’s objectives and the complex cases planned for surgery during this visit were presented at the hospital’s Grand Round. The team also met with the hospital CEO to discuss the scope of the visit and explore the long-term goal of introducing and sustaining microsurgery in Guyana. The day concluded with a formal hospital welcome dinner, with the team and local staff.

The first day of surgery had two operating theatres running simultaneously. In one theatre, the team treated a 14-year-old girl who had sustained a devastating boat propeller injury to her face two months earlier. We performed the first-ever anterolateral free flap in Guyana, which was also the first microvascular anastomosis completed by a Guyanese plastic surgeon. For the two veins both sutures and a coupler were used and we were grateful for the equipment provided by Mercian for microsurgery instruments and Gem for the coupler sets. In the second theatre, two patients underwent unilateral pedicled extended latissimus dorsi flaps for breast reconstruction. These procedures were important in providing local surgeons with hands-on experience and consistency to upskill in these reconstructive techniques.
 

On the second day, Dr Rajkumar raised a free DIEP flap for a delayed reconstruction, under supervision and assisted in the anastomosis. The theatre nurses were excellent, having learnt from the first day about the microsurgery equipment and process. This case was followed by Dr Rajkumar being taken through a unilateral pedicled TRAM flap reconstruction, to complete the variety of local flaps available for breast reconstruction. In the second theatre two patients underwent pedicled extended latissimus dorsi flaps for reconstruction. These procedures provided further training opportunities for the local surgical team, reinforcing the programme’s emphasis on capacity building.
 

On day three, unfortunately ALT free flap performed earlier that week showed signs of compromise. Upon returning the patient to theatre, we found a twisted vein that had compromised the flap. Given the damage, and the need for a successful, well healing flap by the time we left in two days, we decided to raise a new flap from the contralateral thigh to ensure the best possible outcome for the patient. Another ALT flap was raised and anastomosed to the same vessels seamlessly this time. In the second theatre, a patient with a chronic wound from osteoradionecrosis of the chest wall underwent reconstruction. Due to significant vessels damage in the region of the subscapular axis on CT angiography, a contralateral pedicled VRAM flap was performed. This was useful to demonstrate the versatility to local surgeons of the VRAM, superiorly or inferiorly based, or pedicled TRAM for local flap reconstruction.
 

On the final day, the first right-sided microsurgery case in Guyana, a unilateral delayed DIEP, was performed. This required adjustments to the microscope’s positioning, to allow an assistant to view through the 90 degrees lens. A technician from the ophthalmology department was able to troubleshoot this for us after some time, and the case was successfully complete, using the last 9-0 nylon suture in the hospital. Following this final case, we demonstrated the use of chicken models for local surgeons and junior staff to train in microsurgical skills. This will allow them to continue to refine their techniques and gain confidence in microsurgery. The day ended with a final ward round, during which we reviewed postoperative patients and discussed ongoing care with the local staff.

Future Directions
The visit concluded with a shared sense of accomplishment and a clear vision for the future. We discussed the potential for collaboration with surgeons from Jamaica and Trinidad, as well as the development of a Caribbean training program for plastic surgeons, potentially through the University of the West Indies.

We also identified the needs for future trips. Firstly, a day of lectures, teaching and microsurgery skill practice before operating would be a valuable addition. Secondly, we would also like to expand the team on future visits by including a scrub nurse and allied health staff. Thirdly, we faced challenges without our usual equipment and compiled a list of finer instruments, that would make cases smoother for us and trainees learning in Guyana. Finally, we identified a useful area of focus for future visits as orthoplastic lower limb and trauma cases.

The success of the programme was due in no small part to the exceptional coordination by Dr. Shilindra Rajkumar, whose efforts ensured that every aspect of the trip was meticulously organised. We left Guyana with new friendships, shared knowledge, and a commitment to supporting the growth of plastic and reconstructive surgery in the region.

Nepal BFIRST / Cleft UK
In January 2025, a team of six UK-based clinicians travelled to Kirtipur Hospital in Kathmandu, Nepal, for an inspiring and productive week focused on delivering cleft care. The group included two surgeons, an orthodontist, a dentist, a speech and language therapist, and a psychologist. Together, they demonstrated the results achievable through a multi-disciplinary approach, reinforcing the importance of teamwork in cleft care.
Kirtipur Hospital, nestled on the outskirts of bustling Kathmandu, is a dedicated centre for cleft and craniofacial care. The hospital provided an ideal setting for the team to engage with local clinicians and share expertise. A hallmark of the visit was the seamless integration of specialities, where each professional contributed their unique skills to achieve a unified goal: providing holistic care to patients with cleft lip and palate.
 
Collaborating Across Borders

The collaborative spirit of the visit was palpable from the very start. Whether in the operating theatre, dental suites, or therapy rooms, the UK team worked hand in hand with their Nepali counterparts. The orthodontist and dentist formed part of a vibrant dental team that even sang while working, creating a warm and welcoming atmosphere for patients. This sense of camaraderie underscored the ethos of multi-disciplinary care, where shared knowledge and mutual support are key to success.

One of the most rewarding aspects of the trip was the cross-cultural exchange of skills and ideas. For instance, the orthodontist described learning new techniques from the Nepali team, who impressed everyone with their resourcefulness and multi-talented approach. This exchange exemplified how collaboration enriches all participants, ensuring the ongoing improvement of care standards worldwide.
 
Inaugurating the Cleft Fellowship
A significant milestone during the visit was the inauguration of the new Cleft Fellowship. This initiative will enable Dr Bipulesh, a talented Nepali surgeon, to perform cleft surgeries across five outreach centres in Nepal. The programme, funded by CLEFT with the generous support of donors Lord and Lady Stevens, marks an important step in expanding access to specialised cleft care in remote areas. In a memorable ceremony, David Sainsbury presented Dr Bipulesh with a yellow scarf (below), symbolising this new chapter of service and collaboration.

 
Case Studies: Changing Lives
The team’s work had a profound impact on individual patients, many of whom travelled great distances to receive care. One such patient was Surag, age 9, from Chitwan, a 5 hour trip from Kathmandu. He is looked after by his grandmother as his father works in India. He came to the Kirtipur Hospital and was seen by the team after having previously had a cleft repair elsewhere which had unfortunately not healed. Peter Hodgkinson, cleft surgeon, re-repaired his palate and is pictured below left, post surgery, making good progress.

Another case involved Aarab (above right), also 9 years old. Like Surag, Aarab had to travel a long time to reach the hospital. He impressed the team with his extensive knowledge of Mount Everest! He had surgery to help improve the clarity of his speech, a procedure that had not previously been done at the Kirtipur Hospital so this was a great opportunity for the surgeons to demonstrate how it is done.
 
Comprehensive Patient Care
Each clinician brought invaluable expertise to the table, ensuring that every aspect of patient care was addressed. Surgeons performed life-changing procedures to correct cleft conditions, while the dentist and orthodontist ensured optimal dental alignment and oral health. Meanwhile, the speech and language therapist worked with patients to improve their communication abilities, supported by the psychologist, who provided essential mental health support to patients and their families.

Kate Le Marechal is pictured above giving a well received talk on 'The role of the Clinical Psychologist in UK Cleft Team' and 'Personal and Team Psychological Wellbeing'. Both talks prompted a lot of discussion and there are plans to introduce a clinical psychologist in their speech and language therapy sessions.
This holistic approach ensured that patients received comprehensive care, addressing not only their medical needs but also their psychological and social well-being. 
 
A Memorable Journey
The week in Nepal wasn’t all work and no play. The UK team had the opportunity to attend a traditional Nepali wedding, experiencing the rich cultural heritage of the country. These moments of connection added depth to the trip, fostering lasting friendships and a deeper appreciation of the shared humanity at the heart of their work.
Reflecting on the visit, one team member said:
The experience at Kirtipur Hospital was truly exceptional. The dedication and talent of the Nepali team was inspirational. It was a privilege to work alongside them and see the direct impact of our collaboration on patients’ lives.
 
The Power of Teamwork
This visit to Nepal underscored the vital role of multi-disciplinary work in cleft care. By pooling their expertise, the UK and Nepali teams achieved outcomes far greater than any single discipline could accomplish alone. The trip not only improved the lives of countless patients but also strengthened the global cleft care community, setting the stage for future collaborations.

Affiliated BFIRST Projects 

 Breast Cancer Resource for Inter-speciality Training

and Education (BRITE) update

Breast cancer presents a growing and disproportionate health burden in Sub-Saharan Africa. While incidence rates are reported to be lower than in high-income countries, mortality rates are significantly higher, creating a stark and tragic disparity. Despite limited cancer registers in Sub-Saharan Africa, the incidence of breast cancer in Sub-Saharan Africa surged by 247%, with Nigeria accounting for the highest number of cases, between 1990 and 2019. Over the same period, mortality rates in the region increased by 184%, with West Africa experiencing one of the world’s highest burdens.

The existence of a well-functioning multidisciplinary team (MDT) increased the 5-year survival of breast cancer patients by nearly 20%.

Last year plastic surgeons from Ahmadu Bello University Zaria, National Hospital Abuja and University College Hospital Ibadan in Nigeria and the Korle Bu Teaching Hospital Accra and Komfe Anokye Teaching Hospital Kumasi in Ghana in partnership with BFIRST and the Association of Breast Surgeons, UK held BRITE courses across both countries, with both up-to-date treatment options and how to make the MDT work well. Nigerian and Ghanaian scholars from all specialties involved in the MDT visited four units in the UK (Luton and Dunstable, East and Noth Herts, Mersey and West Lankashire, and Manchester University Hospitals). We are indebted to the breast surgeons and radiologist (Miss Ruth James, Harleen Deol, Leena Chagla and Trupti Kulkarin) and their teams who hosted them.

 

 
Here is the team from Zaria, Nigeria, from left to right: Dr Abubakar Muhammad Lawal (Plastic surgery), Dr Nafisa Bello (Radiology) , Mrs Veronica Bako (Breast Care Nurse), Dr Daniyan Muhammad (Breast surgery)  
   

The BRITE team is conducting a questionnaire survey to determine the inter-specialty competencies required by members of the MDT to work together holistically within the breast cancer care pathway.
 

Please click on the appropriate link below for consultants, residents and nurses to take part in the survey. Thank you!

Consultants                    Residents                   Nurses
 

Fellowships

BFIRST Fellows
We have selected six 2025 BFIRST fellows!
Dr Amanuel Tebikew Kebede from Ethiopia
Dr Mekonen Eshete Abebe from Ethiopia
Dr Olatunde Abdul Oyesanya from Nigeria
Dr Most Nurunnahar Begum from Bangladesh
Dr Ebere Oshinachi Ugwu from Nigeria
Dr Nangandu Amanda Malungo  from Kenya
 
We look forward to bringing you updates from the BFIRST fellows visiting in 2025.


Fellow Report: Dr Nur Ul Ain 

The BFIRST Fellowship was an incredible learning experience that profoundly enriched my professional journey and opened new doors for growth and discovery. During the fellowship, I had the privilege of working in both the North and South of the UK, which exposed me to diverse clinical settings and surgical approaches.

My initial placement was at the Mid Yorkshire NHS Trust, where I focused on breast
reconstruction using the DIEP flap technique. I benefited from the latest advancements and state-of-the-art equipment, which not only deepened my technical knowledge but also broadened my understanding of patient care. Additionally, I was exposed to a wide array of cases, including burn care, emergency and elective hand surgeries, and complex breast and perineal reconstructions.

A highlight of my time at Mid Yorkshire was the opportunity to attend the Mid Yorkshire Research Meeting. My supervisor, Mr. Umair Anwar, encouraged my passion for research by facilitating my participation. This allowed me to witness exceptional presentations and innovative studies. The experience inspired me to further explore the integration of research into clinical practice, reinforcing my belief in the importance of evidence-based medicine.

The second phase of my fellowship took me to the John Radcliffe Hospital, part of the prestigious Oxford University Hospitals, where I joined the craniofacial department under the mentorship of Mr. David Johnson. This rotation was truly transformative, as it marked the first time I observed craniofacial surgeries in practice rather than through textbooks. I was particularly fascinated by the well-organized multidisciplinary team (MDT) approach and the state-of-the-art care, which expanded my understanding of the field and sparked a deeper interest in this subspecialty.
 

During my time in the UK, I was fortunate to attend several esteemed conferences and masterclasses, further enhancing my learning. The BAPRAS Congress 2024 in South Wales was an exceptional opportunity to hear from and network with some of the most respected figures in plastic surgery worldwide. I also attended the BAAPS Aesthetic Masterclass, the Face and Body Surgery European Aesthetic Symposium, and the UKAAPS CAPSCO Masterclass on Post-Massive Weight Loss Body Contouring in London. These events offered invaluable insights into the latest techniques and trends in plastic and reconstructive surgery, helping me refine my clinical acumen.

The fellowship was not only about technical skill development but also about the warmth and support of the colleagues and mentors I met along the way. I am deeply grateful to my fellowship supervisors, Mr. Naveen Cavale, Prof. Ash Mosahebi, Mr. Shailesh Vadodaria, Mr. Sanjeeb Majumder, Mr. Stephen Southern, Ms. Rosie Ching, Mr. David Mather, Mr. Mark Swan, Mr. Will Holmes, and Mr. Paul Mohammed for their guidance and encouragement. Their mentorship created an environment where I could thrive and grow both professionally and personally. I also deeply appreciate the wonderful trainees and fellows—Katherine Radcliffe, Yashvinder Kumar, Zhi Ng, Samuel Teklay, Matt Langford, and Ben Patel—who helped me navigate the new healthcare system and made my experience even more enriching.
 
A special mention goes to my dearest friend, Dujanah S. Bhatti, whose unwavering support and encouragement helped me navigate every challenge. Without his guidance and assistance, I would have been lost at many critical junctures during my time in the UK. In conclusion, the BFIRST Fellowship was an extraordinary and transformative experience that I wholeheartedly recommend to all plastic surgeons from middle-income and low-income countries. The exposure to cutting-edge techniques, world-class mentorship, and diverse clinical cases provided an unparalleled opportunity to develop as a surgeon and researcher. This fellowship not only equipped me with advanced skills but also inspired a renewed, sense of purpose and passion for my field. I am immensely grateful for the experiences and relationships I gained during this journey, which will undoubtedly shape the rest of my career.
 
 
Ganga Fellows
Adamtachew Geta and Tigist Zawude are currently at Ganga Hospital in Coimbatore, India, for their Fellowship and microsurgical training.  Here they are with Raja Sabapathy, who heads the Department of Plastic Surgery and hosts our Fellows.

“We would like to thank you (BFIRST) and Professor Raja for the opportunity that you extended to us. We are learning from the hands of well experienced and updated professors at Ganga Medical College Hospital. In addition we have completed one week microsurgery course by successfully anastomosing 1mm rat femoral vessels (end-to-end, end-to-side and interposition venous graft). This does mean a lot for young surgeons like us. It has left positive impact towards microvascular surgery. We are expecting to gain more knowledge and skills in the remaining month here. Thank you again!”
 

Fundraising

This year we will be selling re-usable BFIRST surgical scrub hats! More details to follow!
Funds raised will help us educate and train surgeons in resource limited countries.
 

How can I help?

Volunteering

BFIRST is keen for surgeons, nurses and allied specialists to all get involved. Please do get in touch if you are interested. Reconstructive surgery is a team sport!

Also, if you have ideas for new projects that you would like to start, perhaps in new countries, or in areas we already work in, we would love to hear about these, and discuss further.