Strengthening Plastic Surgery in Europe – ESPRAS Survey at ESPRAS European Leadership Forum (ELF)

Zusammenfassung

Hintergrund Das Exekutivkomitee (ExCo) der ESPRAS hat im Oktober 2020 das erste ESPRAS European Leadership Forum (ELF) initiiert, um den internationalen Austausch zwischen den verschiedenen nationalen plastisch-chirurgischen Gesellschaften zu fördern und eine Plattform für die Bewältigung gemeinsamer Herausforderung bereitzustellen. Das vorgelegte Manuskript präsentiert die wichtigsten Ergebnisse und Schlussfolgerungen dieses Treffens.

Materialien und Methoden Mitglieder des Vorstands (Präsidenten, Vize-Präsidenten, Generalsekretäre) und Delegierte der nationalen Gesellschaften für Plastische Chirurgie diskutierten aktuelle Themen der Plastischen Chirurgie über das virtuelle Konferenzsystem Zoom (Zoom Video Communications, Inc.). Über Zoom erfolgte zudem eine Umfrage zu verschiedenen international relevanten plastisch-chirurgischen Themen.

Ergebnisse Die Durchführung ästhetischer Eingriffe durch Ärzte ohne Facharztweiterbildung in der Plastischen Chirurgie, sowie das Brustimplantat-assoziierte anaplastische großzellige Lymphom (BIA-ALCL) wurden als die wichtigsten internationalen Herausforderungen der Plastischen Chirurgie erkannt, für deren Bewältigung auf europäischer Ebene ein standardisiertes Vorgehen diskutiert wurde. Weiterhin wurden aktuelle Entwicklungen in der Weiterbildung junger Plastischer Chirurgen eruiert, wobei die Etablierung eines europäischen Fellowship Programms von der Mehrheit der Befragten stark befürwortet wurde. Strategien zur Einführung von europäischen Registern für freie Lappenplastiken, Implantate und für die Brustrekonstruktion wurden erörtert.

Schlussfolgerung Das ESPRAS ELF stärkt den internationalen Austausch und die europäische Einheit in der Plastischen Chirurgie. Ein weiteres virtuelles Webinar mit dem Thema „Strategien zur Stärkung und Verteidigung der Plastischen Chirurgie gegenüber anderen“ wurde für das Frühjahr 2021 terminiert.

Abstract

Background The Executive Committee (ExCo) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) organized a first ESPRAS European Leadership Forum (ELF) to facilitate international exchange and to provide a platform for international leaders and delegates of national societies of Plastic Surgery to discuss common challenges. The presented manuscript presents key findings in a first effort of international harmonization and cooperation.

Materials and Methods Members of the executive (presidents, vice-presidents, secretary generals) and national delegates of Plastic Surgery national societies discussed hot topics in Plastic Surgery via the Zoom virtual conferencing system (Zoom Video Communications, Inc.). Attending participants responded to a virtual question & answer session with questions being displayed throughout the webinar.

Results The challenges associated with Aesthetic Surgery performed by doctors who are not board-certified Plastic Surgeons and Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) were perceived as major hot topics within most national societies. Both topics were discussed vividly. Education in plastic surgery and a European fellowship program for young Plastic Surgeons was favored by a large majority of participants. The implementation of European registries for free flaps, implants and for breast reconstruction were supported by the majority of respondents.

Conclusion The ESPRAS ELF provides a platform to propel international exchange and alliance, communication, education, research and future projects. A further virtual webinar with the topic “Strategies for Strengthening and Defending Plastic Surgery against Others” was suggested to be conducted in spring 2021.

Schlüsselwörter

Akademische Plastische Chirurgie - Europäische Plastische Chirurgie - Brustimplantat-Register - Rekonstruktive Chirurgie

Key words

Academic Plastic Surgery - European Plastic Surgery - Breast-Implant Registry - Reconstructive Surgery

Introduction

The European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS), founded in 1967, is the umbrella organization of all European plastic-surgical national societies. Its aim and purpose is to promote the field of Plastic, Reconstructive and Aesthetic Surgery in Europe. Thereby, it supports education, training and research, encourages the exchange of knowledge and ideas between Plastic Surgeons in European countries, facilitates cooperation between national member societies and promotes ethical behavior in all aspects of practice, education and research [1]. Each member of a member national society for Plastic, Reconstructive and Aesthetic Surgery in Europe is a member of ESPRAS, thus it currently includes over 7000 members.

Fig. 1 ESPRAS European Leadership Forum with participating national societies from all over Europe.

The need for strong European partnerships within national societies has recently become most evident: In times of crisis, international cooperation is key and harmonization of efforts to overcome common issues, such as the ongoing COVID-19 pandemic, is indispensable. In this regard, ESPRAS conducted a European Survey and organized, together with the European Association of societies of Aesthetic Plastic Surgery (EASAPS), a webinar on considerations of getting back to work in Plastic Surgery with the COVID-19 pandemic, based on international standards and European consensus [2], [3].

To facilitate further international exchange and to provide a platform for international leaders and delegates of the national societies of Plastic Surgery to discuss common challenges, the Executive Committee (ExCo) of ESPRAS organized a first ESPRAS European Leadership Forum (ELF). The aim was to identify challenges for national societies and share solutions on a European level in a further ESPRAS European Survey.

Materials and Methods

To promote closer co-operation throughout societies of Plastic Surgery in Europe, ESPRAS initiated a virtual European Leadership Forum on October 2nd 2020 with the motto “More Impact – TOGETHER”. Members of the executive (presidents, vice-presidents, secretary generals) and national delegates of plastic surgery national societies were invited to contribute and participate in a virtual meeting (two-sessions over an afternoon). Participants both from mandated ESPRAS societies and guest participants from non-member countries were welcome, in order to be transparent and open for all partners. Due to the SARS-CoV-2 pandemic and the associated restrictions, the European Leadership Forum, which was originally planned to be held in Munich, Germany, was organized virtually. Hot topics with the clear need of European harmonization were identified and discussed, including an online international question & answer session which was held via the Zoom virtual conferencing system (Zoom Video Communications, Inc.). Attending participants from all over Europe were asked to answer questions that were displayed throughout the webinar. The meeting was recorded, and the Zoom Recording is available in the restricted member area of the ESPRAS website (www.espras.org).

Results

52 participants (presidents, vice-presidents, secretary generals and delegates) from over 30 European countries ([ Fig. 1 ], [ Table 1 ]) joined the virtual ESPRAS European Leadership Forum and responded to the poll.

Tab. 1 ESPRAS European Leadership Forum with participating national member societies and guest participants from all over Europe plus the U.S. and Russia.

Participants from mandated societies	Guest participants
Austria	Belgium
Belarus	Czech Republic
Bosnia and Hercegovina	France
Bulgaria	Norway
Croatia	Russia
Cyprus	U.S.A.
Denmark
Estonia
Finland
Germany
Greece
Ireland
Italy
Lithuania
Montenegro
Netherlands
North Macedonia
Portugal
Romania
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Turkey
Ukraine
U. K.

Most European national societies of plastic surgery have less than 300 members, but more than 100 members (35 %; 9/27). More than half of all national societies have 300 or less members (56 %; 15/27). One European national society reported less than 1500, but more than 1000 members (4 %; 1/27) and one society reported more than 1500 members (4 %; 1/27) ([ Fig. 2 ]).

Fig. 2 Poll 1 ESPRAS Demographics. Bar graph showing respondents answer in % for respective questions.

A total of 37 participants responded to the second poll inquiring about the five hottest topics in Plastic Surgery in the participants national societies ([ Fig. 3 ]). Two topics were ranked highest, both reaching 68 % (25/37) of all participants votes: The challenges associated with Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Aesthetic Surgery performed by doctors who are not board-certified Plastic Surgeons, were perceived as major hot topics within most national societies, requiring streamlined European consensus. 62 % (23/37) of the respondents found the implementation of breast implant registries to be of significant importance, followed by education (57 %; 21/37), the implications of the COVID-19 pandemic (51 %; 19/37), social media regulations and code of conduct (43 %; 16/37), the strengthening of academic plastic surgery (32 %; 12/37) and fat grafting and stem cell regulations (27 %; 10/37). New European regulations for medical products and commerce instead of medicine in Plastic Surgery ranked last, both receiving 14 % (5/37) of participants votes.

Fig. 3 Poll 2 Hot topics in national societies. Bar graph showing respondents answer in % for respective questions.

A total of 34 participants responded to a poll determining the need for joint ESPRAS projects ([ Fig. 4 ]). An overwhelming majority of respondents agreed with the implementation or continuation of strong European educational programs for young Plastic Surgeons. 97 % of all participants responded that education and European international exchange should be strengthened by ESPRAS and voted in favor of an ESPRAS fellowship program that offers scholarships to young Plastic, Reconstructive and Aesthetic Surgeons by sponsoring them to visit centers of excellence in Europe.

Fig. 4 Poll 3 ESPRAS Projects; European Education, Registries and Surveys. Bar graph showing respondents answer in % for respective questions.

In terms of registries, 79 % (27/34) of respondents found that ESPRAS should build European registries for specific issues such as free flaps, breast reconstruction, or breast implants. The need for detailed ESPRAS European surveys on topics such as breast surgery, breast reconstruction and other professional issues was supported by 97 % (33/34) of all respondents.

Importantly, 85 % (29/34) of all respondents were interested in taking an active role in ESPRAS projects.

A total of 39 participants responded to questions regarding organizational issues of the newly introduced format of the ESPRAS ELF ([ Fig. 5 ]). 95 % (37/39) of all respondents found that regular ESPRAS ELFs would be helpful for their national societies. 49 % of all respondents saw the need for annual meetings, while 46 % would even prefer meetings twice a year. Hereby, the majority of participants (77 %; 30/39) propose that future meetings should be organized both virtual and in person.

Fig. 5 Poll 4 Organizational aspects of the European Leadership Forum (ELF). Bar graph showing respondents answer in % for respective questions.

Over 90 % (28/31) of all respondents stated that the COVID-19 pandemic significantly reduced the activity of their national society and the plastic surgery care in their country ([ Fig. 6 ]). In May 2020, ESPRAS analyzed the impact of the COVID-19 pandemic on Plastic Surgery in Europe [2] and, together with EASAPS, provided recommendations on getting back to work [3].Over 55 % (17/31) of all respondents reported reading the manuscripts, and finding the considerations and recommendations helpful for clinical practice and the practice of other colleagues in their country.

Fig. 6 Poll 5 Sars-CoV-2 and COVID-19. Bar graph showing respondents answer in % for respective questions.

Discussion

The ExCo of ESPRAS initiated a virtual European Leadership Forum (ELF) to provide a platform for international discussion of a diverse set of topics relevant for societies of Plastic Surgery all across Europe. ESPRAS is the umbrella society to all member European National Plastic Surgery societies. As such, it is uniquely positioned to coordinate a response to the common issues that affect plastic surgeons throughout Europe.

This paper summarizes the results and the discussion of the first ELF based on poll questions that were displayed throughout the webinar. Most participants stated that Aesthetic Surgery performed by doctors who are not board-certified Plastic Surgeons and BIA-ALCL are major hot topics within their individual national societies. BIA-ALCL, classified as a lymphatic neoplasm by the World Health Organization in 2016, is a malignant disease that has been associated with textured breast implants and has led to a great level of uncertainty in both patients and the public [4], [5], [6], [7], [8], [9], [10].As Plastic Surgeons, it is our duty to understand this rare disease, to recognize it at an early stage and help those affected. As the use of textured implants is preferred in Europe, there is a definite need for clear recommendations for action and harmonization of approaches on a European level.

Non-certified Plastic Surgeons pose a major threat to our profession. Being a Plastic Surgeon requires specialized training, surgery practiced at the highest standards with patient safety at its core. Many nations, however, allow doctors to perform plastic surgical procedures without being accredited by a national board of Plastic Surgery. Our profession is ultimately discredited, if complications occur by procedures performed by unqualified practitioners. This is especially true for Aesthetic Plastic Surgery. The majority of respondents thus see this as a major threat across all national societies, requiring also a strong European standpoint.

Specific ideas were presented and discussed with regard to education in Plastic Surgery and a European fellowship program was favored by a large majority of participants. The young generation of plastic surgeons was represented by PLASTA (UK plastic surgery trainee association) who encouraged international cooperation between young plastic surgeons across Europe to further advance the field of Plastic Surgery and build strong ties for the future.

The implementation of European registries for free flaps, implants and for breast reconstruction were discussed vividly. A great need for high quality international data in these areas was recognized. Details with regard to international data protection laws, database management and maintenance on European level have to be elaborated in further meetings. The drive for change was highly visible, with over 85 % of participants willing to play an active role in ESPRAS projects and in pushing ideas forward. As a first step, international detailed ESPRAS European surveys on topics such as breast surgery, breast reconstruction and other professional issues, also supported by over 95 % of all respondents, will be designed, in order to establish European standard operating procedures.

The impact and importance of joint international efforts in tackling common issues that affect all national plastic surgical societies became visible, as over 50 % of all participants reported to have profited from ESPRAS European guidelines and recommendations of getting back to work in Plastic Surgery during the ongoing COVID-19 pandemic [2], [3].

Currently, there exist several European societies for Plastic Surgery ([ Table 2 ]). While all follow the aim of strengthening European Plastic Surgery, they are either focused on special topics or issues of Plastic Surgery or restrictive in membership. A presentation on unifying European Plastic Surgery societies and the debate that followed showed that there is a clear need to coordinate all efforts to gain more visibility and drive forward common issues of Plastic Surgery. Greater cooperation between European societies ([ Table 2 ]) is currently being explored.

Tab. 2 Overview of European societies of Plastic Surgery.

European societies of Plastic Surgery
European Association of Societies of Aesthetic Surgery (EASAPS)
European Federation of Societies for Microsurgery (EFSM)
European Society of Aesthetic Surgery (ESAS)
European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS)
International Confederation of Plastic Surgery Societies Europe (ICOPLAST European Chapter)

As a next step, delegates of aforementioned European societies are invited to join ESPRAS 2022 congress in Gaia/Porto in Portugal, where options for stronger collaboration between European societies will be discussed, hopefully in person. The goal is to unite all European societies and develop a continental power to protect and strengthen our specialty. Furthermore, due to the great and positive response of all participants, of which 95 % found that regular ESPRAS ELFs would be helpful for their national societies, a further virtual webinar with the topic "Strategies for strengthening and defending the specialty of plastic surgery’' has been proposed for the spring of 2021.

Limitations of this study lie within the study design, being an electronically disseminated questionnaire distributed only to the participating executive and delegates of national societies of plastic surgery who had received an invitation to join the webinar. Thus, responses are not without bias. Potentially only surgeons with a particular interest in the matter of the respective topics completed the questionnaire. Further, sample size is an issue, which is why large European questionnaires are necessary to validate the findings of this study in the future. The next ESPRAS Survey will focus on breast reconstruction. A questionnaire is being prepared.

Conclusions

Close co-operations throughout societies of Plastic Surgery in Europe strengthen our specialty, sharpen our profile and increase our visibility and influence within the medical profession. The virtues of strong European partnerships are evident, and the ESPRAS European Leadership Forum (ELF) provides the exact platform to propel international exchange and alliance, communication, education, research and future projects.

Conflict of interest

The authors declare that there is no conflict of interest.

• References

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Publication History

Received: 12 October 2020

Accepted: 17 October 2020

Article published online:
04 November 2020