Dr David Lesniak

My name is David LESNIAK. I’m a Canadian general surgeon visiting Paris. I specialize in breast cancer surgery in Canada. But I’ve come to Paris to get more expertise in not only cancer surgery but also learned some plastic surgery techniques at the Paris Breast Centre.

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Dr David Lesniak Breast and general surgeon

Why doing a fellowship at the paris- breast- centre ?

Towards the end of my training I began looking for fellowship opportunities in Canada, United States and abroad. I visited many programs in both Canada and the United States but ultimately decided to come to Paris-France because I believe it’s a unique opportunity.

Throughout my training I learned that the techniques practiced in Europe were different than the techniques we practiced in Canada. In Europe it’s a truly integrated model between not only excellent cancer surgery but also incorporating plastic surgery techniques into their treatment. This model appealed to me very much throughout my training and my reading and my research.

I continue to see the Paris Breast Centre as a place that was advancing the field and setting the trend. And I think that really spoke to me as a great opportunity to learn some of these techniques and take them back to Canada. There’s a level of expertise in France, in Europe specifically at the Paris Breast Centre that I don’t think you can obtain in Canada the United States. Their unique model, their unique approach to breast cancer was something that I wanted to take back and pursue.

The concept of oncoplastic surgery started in Europe and I think the team at the Paris Breast Center were paramount in developing these techniques. I think that these techniques are slowly getting integrated in the United States and Canada. But we have not made the jump to these techniques at this point. The best opportunity for me was to come to Paris and to learn from the group at the Paris Breast Centre who are truly the world leaders when it comes to oncoplastic breast surgery incorporating plastic surgery techniques into breast oncology. It’s an idea that was started by Dr. CLOUGH and his team in Paris.

What did you learn?

My time in France I do not consider it as a sacrifice at all. I have thoroughly enjoyed working with the team at the Paris Breast Centre. I think I’m learning new things every day whether it be surgical techniques or patient management decisions or wound care tricks or how to set up an office, how to run an integrated Breast Centre. So to me I’m not sacrificing anything. I think it’s a great opportunity. I’m very honored to be given the opportunity.

I think the instruction is great. Dr. CLOUGH and Dr. SARFATI are excellent teachers in the operating room, always explaining what they’re doing. I truly believe this is training that I wouldn’t have obtained in Canada or the United States.

Differences between countries

In terms of treatment differences between Canada and France, I think that in general the principles of cancer surgery are the same. I think that we use the same criteria to select our patients. I think that we use the same operations, breast conservation or mastectomy. Where I see the big difference is the integration of not only cancer but of incorporating the overall results and the patient’s body image right from the start of the treatment that is integrated in especially at the Paris Breast Centre.

Number one, the cancer is the priority but number two, right from the first visit there is a concept that this patient is going to undergo an operation and ultimately needs to be satisfied with her appearance and her body image after the surgery And I think that is a major difference.

Another great thing in Paris is the ability to do research at the Paris Breast Centre. They have a very comprehensive database. They’ve been in practice for almost a decade now, over a decade. So they’ve accumulated a great amount of data using these oncoplastic techniques. So there’s been a number of excellent research opportunities, they’re very supportive of publishing and always have new ideas.

Scientific publications

During my time in Paris, I’ve been here four months now, just completing my first article on treating breast cancers in women with previous breast augmentation. I think it will be a very strong paper. I’ve started collecting data for two other papers involving Lipofilling in breast cancer patients. Ultimately with the team here I would hope to publish three or four articles in a year maybe more. But it’s been a very supportive environment and I think the opportunities are there for you if you want to work at them and there’s a lot of opportunities to publish in Paris. And I think that’s something that I’m really looking forward to and it’s really been valuable to me.

Going forward

When I return to Canada my dream job would be to be working in breast surgery alone. To set up a breast team in Canada, to be a part of a breast team, including oncologists and plastic surgeons and to almost try to replicate the model that I’ve seen in Paris.

I look forward to not only going back and taking this approach for my patients but also to help train future generations of residents and trainees interested in breast surgery the techniques that I’ve learned in Paris, I think it can be a valuable tool to add to the skill set of many surgeons in Canada and I truly believe the model is viable in the Canadian system. ​

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