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.
