Center of Excellence in Breast Treatment

In partnership with key opinion leaders and industry professionals, SRC developed the Center of Excellence in Breast Treatment (COEBT) program. The COEBT program identifies surgeons and facilities that provide excellent breast surgical care and are dedicated to continuously improving healthcare quality and patient safety.

The COEBT program addresses issues facing the specialty, including:

  • Identifying the best breast cancer treatment facilities and surgeons in Brazil
  • Continuously improving healthcare quality, costs and outcomes
  • Eliminating use of outdated procedures
  • Establishing universal standards to measure program performance
  • Establishing and maintaining a central patient outcomes database to improve the specialty

The COEBT program is endorsed by the Brazilian Society of Mastology.
Click here to see a recent announcement of SRC’s collaboration with the Society.

Ready to Apply?

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Program Requirements

Requirement 1 – Institutional Commitment to Excellence

The applicant facility demonstrates a commitment to excellence in breast treatment from the highest levels of its medical staff and administration.

This commitment includes having specialty-specific credentialing and privileging guidelines.

Requirement 2 – Breast Surgery Experience

The applicant facility performs at least 100 breast surgery procedures annually.

Each applicant surgeon has served as the primary surgeon for at least 200 breast surgery procedures in their lifetime and performs at least 100 procedures annually.

Brazilian applicant surgeons must be a member of the Brazilian Mastology Society (Sociedade Brasileira de Mastologia).

For surgeons, procedures performed at any facility may be used toward volume. Surgeons must have served as the primary surgeon for a procedure to qualify. If the surgeon’s role as primary surgeon has been properly documented, procedures performed during fellowship may qualify. Cases in which the surgeon served as co-surgeon or assisting surgeon do not qualify.

Each procedure used for volume must be thoroughly documented to enable a medical chart review.

Volume waivers may be approved in some circumstances.

Required services or components that should be available to patients:

  • Imaging
  • Screening mammography (digital or analog)
  • Diagnostic mammography
  • Ultrasound
  • Breast MRI
  • Needle Biopsy
  • Needle biopsy – palpation-guided
  • Image guided – stereotactic
  • Image guided – ultrasound
  • Image guided – MRI
  • Pathology
  • Report Completeness/CAP Protocols
  • Radiology-Pathology Correlation
  • Prognostic and predictive indicators
  • Gene studies (if available)
  • Genetic Evaluation and Management
  • Genetic testing
  • Genetic risk assessment
  • Genetic counseling
  • Surgical Care
  • Surgical correlation with imaging
  • Preoperative planning after biopsy for surgical care
  • Breast surgery: lumpectomy or mastectomy
  • Lymph node surgery: sentinel node/axillary dissection
  • Post initial surgical correlation/treatment planning
  • Plastic Surgery Consultation/Treatment
  • Tissue expander/Implants
  • TRAM/Latissimus flaps
  • DIEP flap/free flaps (if available)
  • Medical Oncology Consultation/Treatment
  • Hormone therapy
  • Chemotherapy
  • Biologics
  • Chemoprevention
  • Radiation Oncology Consultation/Treatment
  • Whole breast irradiation with or without boost
  • Regional nodal irradiation
  • Partial breast irradiation
  • Palliative radiation for bone or systemic metastasis
  • Stereotactic radiation for isolated or limited brain metastasis

Qualifying Procedures that count toward surgical volume:

  • Excisional biopsies
  • Lumpectomy
  • Mastectomy (partial or complete)
  • Lymph node sentinel dissection
  • Lymph node axillary dissection
  • Therapeutic oophorectomy
  • Breast reconstruction

Requirement 3 – Physician Program Director

The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Breast Treatment (COEBT) program.

The Physician Program Director(s) must: 

  • Be accredited, or in the process of becoming accredited as a Center of Excellence in Breast Treatment (COEBT) surgeon.
  • Be primarily responsible for coordinating the multidisciplinary services and systems for breast treatment.
  • Participate in multidisciplinary team meetings.
    • Multidisciplinary team meetings should be held monthly (unless determined otherwise by volume consideration) to ensure that decisions related to breast surgery are addressed in a comprehensive manner.

Topics of discussion to include for multidisciplinary team meetings:

  • History and findings
  • Imaging studies
  • Pathology
  • Pre-and post-operative treatment
  • Readmissions
  • Reoperations
  • Complications
  • Mortalities
  • Administrative needs or issues (should they arise)

Requirement 4 – Consultative services

The applicant facility must have an intensive care unit and a full complement of consultative services required for the routine and intensive care of breast surgery patients and their potential complications.

  • During surgery and until discharge from the post-anesthesia care unit (PACU):
    • Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all surgery patients and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA must be available onsite within 30 minutes if needed.
  • Available on-site 24/7 (or at all times when patients are present):
    • Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
  • Available on site within 60 minutes:
    • Gynecologist
    • Oncologist
    • Breast surgeon
    • Plastic surgeon
    • Radiologist
    • Radiation therapist
    • Interventional radiologist
    • Physician with critical care credentials to manage complications, specifically a critical care physician/intensivist, hospitalist, cardiologist or pulmonologist
  • The facility is also able to identify the following consultative staff:
    • Cardiologist
    • Endocrinologist
    • Pathologist
    • Pulmonologist
    • Physician trained in genetic evaluation and management

Requirement 5 – Equipment and Instruments

The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for breast treatment patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.

If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.

  • Operating rooms
    • Dedicated instruments and trays necessary for diagnostic, therapeutic, and reconstruction breast procedures
    • Operating room table(s)
    • Positioning devices
    • Monitoring equipment
    • Patient transfer equipment
    • Difficult intubation cart
    • Crash/code cart
  • Post-anesthesia care unit
    • Gurneys and/or beds
    • Patient transfer equipment
    • Monitoring equipment
    • Crash/code cart
  • Dedicated inpatient and/or outpatient patient floor or care area(s)
    • Beds
    • Wheelchairs
    • Patient transfer equipment
    • Crash/code cart
  • Emergency department or intensive care unit on the premises
    • Hemodynamic monitors
    • Ventilators
    • Crash/code cart

Requirement 6 – Surgeon Dedication and Qualified Call Coverage

Each applicant surgeon spends a significant portion of their efforts in the field of breast treatment and has active, full privileges in their specialty at the applicant facility.

Each applicant surgeon is board-certified or an active candidate for board certification in their surgical specialty by the highest certifying authority available.

Each applicant surgeon must complete at least 24 hours of continuing medical education (CME) focused on breast care every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or two national or international meetings qualify.

The applicant facility has policies in place that require all COEBT surgeons to have qualified call coverage, and each applicant surgeon certifies that each covering surgeon is capable of identifying and treating complications.

Each covering surgeon is board-certified or an active candidate for board certification specified by the highest certifying authority available and has admitting privileges at the co-applicant facility.

Requirement 7 – Clinical Pathways and Standardized Operating Procedures

The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for breast treatment procedures. The following pathways are required:

  • Anesthesia, including monitoring and airway management
  • Perioperative care, including monitoring, pain management and airway management
  • Deep vein thrombosis (DVT) prevention and management

The first three pathways will be deemed satisfied if the facility has accreditation from The Joint Commission (formerly known as JCAHO), DNV-GL or an equivalent healthcare organization approved by SRC.

  • Instructions for identification, evaluation and management of early warning signs of complications.
  • Preoperative patient preparation, evaluation, patient education (to include potential diagnostic tests, including genetic when appropriate), consent and plan of action for discharge that includes follow-up and any necessary patient education
  • Post therapy/procedure/surgery patient rehabilitation
  • Evaluation and plan of action for patients at high risk for malignancy, including when a malignancy is detected

Requirement 8 – Team and Support staff

The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as an operative team trained to care for breast treatment patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, patient navigation, multidisciplinary team meetings and ongoing breast surgery program compliance.

The applicant facility provides ongoing, regularly scheduled staff in-service education to ensure applicable staff have a basic understanding of breast treatment and the appropriate management of the breast surgery patient.

In-service topics must include: 

  • Signs and symptoms of common complications following breast treatment/interventional breast procedures
  • Proper use of diagnostic and surgical equipment
  • Clinical pathways
  • Continuing medical and nursing education
  • Education of nurses in specialized knowledge and skills related to breast treatment

Requirement 9 – Patient Education

The facility and each applicant surgeon must provide all breast treatment patients with comprehensive preoperative patient education.

The facility and each applicant surgeon must also have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for each patient’s condition.

The applicant provides organized and supervised support groups for all patients who may undergo or have undergone breast treatment.

Requirement 10 – Continuous Quality Assessment

Each applicant surgeon must collect prospective outcomes data on all patients who undergo breast treatment in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.

Program Fees

Initial Fees

Facility Application Fee: $4,500 USD
Surgeon Application Fee: $750 USD

  • Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
  • Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.

Site Inspection Fees

Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD

  • The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to the site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
  • Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
  • Renewal inspections are required every three years to ensure ongoing program compliance.

Annual Fees

Facility Annual Fee: $4,500 USD
Surgeon Annual Fee: $750 USD

  • Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.

Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.