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The British Association of Aesthetic Surgeons (BAAPS) Annual meeting 2018

The British Association of Aesthetic Surgeons (BAAPS) Annual meeting 2018

The British Association of Aesthetic Surgeons (BAAPS) Annual meeting 2018 took place on the 4th & 5th October at London Olympia focusing on blending surgical and non-surgical techniques to achieve the best results in facial rejuvenation and body contouring.

BAAPS was created to promote excellence in aesthetic cosmetic surgery to improve overall safety standards, and to enhance the education of the public about aesthetic cosmetic surgery, and in particular the benefits and risks of different procedures. The BAAPS meeting ran alongside the CCR Expo meeting and this year saw live non-surgical demonstrations within the BAAPS meeting.

It was a great honour to share my personal experience in relation to the mummy makeover procedure, fleur de lis abdominoplasty and body lifting with my colleagues and to be given the opportunity to meet and discuss experiences with an international panel of experts. A wide variety of body contouring procedures were discussed and it was refreshing to here so may different opinions and results.

There is an increasing need to offer a wide variety of options to patients, often involving multiple surgical sites. It is clear that the variety of combinations that can be performed simultaneously is expanding.

Ultimately, the feasibility of combining body and breast rejuvenation surgery rests on the requirement that the entire operation must be as safe as each of its component procedures if performed individually.

In facial surgery key opinion leaders debated the pros and cons of a wide variety of surgical options for facial surgery. There were live non-surgical demonstrations and a robust discussion on the treatment of the anterior neck when combined with face lifting. The pros and cons of many rejuvenative techniques such as brow lifting, fat transfer and facial implants in order to improve facial aesthetics were debated. The blending of non-surgical and surgical techniques was reflected by the wide variety of clinical experts.

It was a privilege to be part of the international faculty, to learn and exchange ideas in order to continue to improve the quality of care for patients.

Meeting Programme | The British Association of Aesthetic Plastic Surgeons

Advanced Breast Augmentation Workshop

As part of the Johnson and Johnson global teaching council Mr Ross continues to deliver educational events related to breast rejuvenation on a regular basis.

This advanced breast augmentation course for consultants aims to give delegates an insight into advanced augmentation and patient management techniques. including asymmetry and breast implant salvage techniques.

Mr Ross is joined by Mr Paul Harris (London) to give one of the most comprehensive updates on the use of Mentor breast implants at the Johnson and Johnson Pinewood Campus.

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Breast implant related Anaplastic Large Cell Lymphoma

On the 6th July 2016 the French Regulator: ANSM issued a press release regarding cases of Anaplastic Large Cell Lymphoma that have been identified in France in women with breast implants1. Concerns have subsequently been widely reported in the media.

Mr Ross would like to reassure patients that breast implant related Anaplastic Large Cell Lymphoma (Bi – ALCL) remains a rare condition that has been identified in 250 patients worldwide, with to date 8 deaths reported. According to BAAPS it appears that there are at least 13 cases identified in the UK. It is estimated that 100 million women have had breast implant insertion worldwide. (Current estimated incidence 1:400,000 and mortality of 1:12,500,000.)

What is ALCL?

ALCL (anaplastic large cell lymphoma) is a rare type of non-Hodgkin lymphoma that was first reported in 19972. ALCL is diagnosed in approximately 1 in 500,000 women in the US annually, while ALCL involving the breast is even more rare (affecting ~3 in 100 million US women annually).3 ALCL is characterized by abnormal growth of large T-cells3 .These cells can appear in the skin, soft tissues, lymph nodes, bones, soft tissues, lungs, or liver, whereas cutaneous ALCL, limited to the skin, typically has a favorable prognosis.4-6

What are the clinical features of ALCL in women with breast implants?

ALCL in women with breast implants generally presents as a late seroma (ie, developing at least 12 months after the most recent surgery)5-9 or palpable mass. Lymphoma cells are found in the seroma fluid or in the fibrous capsule rather than in the breast tissue.3 Like cutaneous ALCL, ALCL in women with breast implants generally has a favorable clinical course.5,11 In most cases, women presenting with seroma with or without severe capsular contracture have had positive outcomes after surgical removal of the implant.5,11 Some evidence, however, suggests that ALCL patients presenting with a mass have an increased risk of relapse or refractory disease.5 Complete surgical excision of lymphoma, implants, and the surrounding fibrous capsule is the optimal approach for the management of patients with BI-ALCL11.

How are ALCL cases in women with breast implants monitored?

In the US, the FDA tracks reports of ALCL in breast implant patients through the Manufacturer and User Facility Device Experience (MAUDE) database. This publicly-available system includes voluntary reports of adverse events from healthcare professionals and consumers (since 1993) and mandatory reports from manufacturers (since 1996), importers (since 1993) and user facilities (since 1991).10 ALCL cases occurring within the UK should be reported to the MHRA12.The relationship between implants and Bi-ALCL is also being investigated in France and Australia1, 13. The French medicines regulatory agency, which has given manufacturers until July 2017 to prove their products are safe or face having them banned.

How is it diagnosed?

Because the surgical findings associated with ALCL are extremely variable, clinical experts recommend that fresh seroma fluid and representative portions of the capsule be examined pathologically when ALCL is suspected.3,10
It is Mr Ross’s routine practice to send pathological specimens of the capsule for analysis in all cases of implant removal or implant based revisionary surgery. For patients with late onset seroma fluid is always sent for analysis and a total capsulectomy is recommended. This provides valuable reassurance to patients and all patients treated by Mr Ross for late onset seromas +/- mass have all been treated with total capsulectomy.

Is ALCL linked to a certain type of implant?

While tracking an ALCL case may be straightforward in women who have had only one breast implant, interpreting the case history becomes more difficult when patients have had multiple implants. One of the difficulties in determining causation is that many of those patients who have presented with breast implant related ALCL have had many different forms of implants at various time frames.
Although both smooth and textured devices have been reported10,14 it is believed that ALCL may be more common in textured implants and specifically in aggressively textured implants15. There is evidence emerging that subclinical infection may a contributing cause15.
When looking at the numbers of cases of ALCL it is important to compare this number against the worldwide numbers of implants per company and this requires prospective accurate data collection through an implant registry.
In Mr Ross’s practice all patients will receive the details of their implants and the implant details are recorded on the hospital registry. The UK is currently developing a breast and cosmetic implant registry that will allow identification of possible trends and complications relating to specific implants16.

Mr Ross’s philosophy regarding Bi-ALCL

Although Bi-ALCL is extremely rare it is important that patients understand that there is a risk currently being investigated worldwide. As part of the consent process all patients must be aware of the risk of Bi-ALCL17. Although Mr Ross has implanted thousands of breast implants he is not aware of any cases of ALCL in his practice. For all breast implant removal cases and implant revision cases Mr Ross always sends a sample of the capsule for pathological analysis. In the case of late onset seroma fluid is always sent for analysis patients and in this scenario patients undergoing implant removal / replacement have all been treated with total capsulectomy.


References

1. 14. Agence Nationale de Sécurité du Médicament et des Produits de Santé. https://ansm.sante.fr/S-informer/Actualite/Lymphome-Anaplasique-a-Grandes-Cellules-associe-aux-implants-mammaires-LAGC-AIM-Point-sur-les-investigations-en-cours-Point-d-Information Accessed July 11th 20162. Keech JA Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100:554–555.

3. US Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. January 2011. Available at
https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239996.htm. Accessed July 11th 2016

4. Stein H, Foss HD, Dürkop H, et al. CD30+ anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features. Blood. 2000;96:3681–3695.

5. Thompson PA, Prince HM. Breast implant-associated anaplastic large cell lymphoma: a systemic review of the literature and mini-meta analysis. Curr Hematol Malig Rep. 2013;8:196–210.

6. Ferreri AJM, Govi S, Pileri SA, Savage KJ. Anaplastic large cell lymphoma, ALK-negative. Crit Rev Oncol Hematol. 2013;85:206–215.

7. Spear SL, Rottman SJ, Glicksman C, Brown M, Al-Attar A. Late seromas after breast implants: theory and practice. Plast Reconstr Surg. 2012;130:423–435.

8. Brody GS. Brief recommendations for dealing with a new case of anaplastic large T-cell lymphoma. Plast Reconstr Surg. 2012;129:871e–872e.

9.Taylor CR, Siddiq IN, Brody GS. Anaplastic large cell lymphoma occurring in association with breast implants: review of pathologic and immunohistochemical features in 103 cases. Appl Immunohistochem Mol Morphol. 2013;21:13–20.

10. US Food and Drug Administration. MAUDE – Manufacturer and user facility device experience. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm481899.htm Accessed July 11th 2016

11. Clemens MW, Medeiros LJ, Butler CE et al. Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol. 2016 Jan 10;34(2):160-8.

12. Medicines and Healthcare Products Regulatory Agency. Medical device alert. Available at https://www.gov.uk/drug-device-alerts/medical-device-alert-breast-implants-report-cases-of-anaplastic-large-cell-lymphoma-alcl Accessed July 11th 2016

13. Australian Government. Department of Health Therapeutic Goods Administration. https://www.tga.gov.au/committee-meeting-info/acsmd-meeting-statement-meeting-9-9-april-2015 Accessed July 11th 2016

14. Adams WP Jr. Discussion: Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Plast Reconstr Surg. 2016 Jun;137(6):1670-2.

15. Hu H, Johani K, Almatroudi A, Vickery K, Van Natta B, Kadin ME, Brody G, Clemens M, Cheah CY, Lade S, Joshi PA, Prince HM, Deva AK. Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Plast Reconstr Surg. 2016 Jun;137(6):1659-69.

16. Health and Social Care Information Centre https://www.hscic.gov.uk/bcir Accessed July 11th 2016

17. Clemens MW1, Miranda RN, Butler CE. Breast Implant Informed Consent Should Include the Risk of Anaplastic Large Cell Lymphoma. Plast Reconstr Surg. 2016 Apr;137(4):1117-22.

BAPRAS Breast Nurse Day in Manchester

Mr Ross was invited by BAPRAS to be part of the faculty for the BAPRAS Breast Nurse Day in Manchester. Mr Ross chaired a session and presented on the role of reconstructive surgery in risk reducing breast surgery.

 

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Mr Ross launches Allura (Mentor CPG) implants in China

From the 7th March – 10th March 2016 Mr Ross represented Johnson and Johnson and Mentor implants in China. Mr Ross visited a number of hospitals delivering education into the use of Mentor CPG implants across China including hospitals in Changsha, Nanjing and Shanghai. It was an honor for Mr Ross to be invited to the launch of the new CPG range of Mentor implants in China “Allura” at the Intercontinental Hotel in Shanghai on the 10th March and deliver his experience. The launch was a huge success and Mr Ross would like to thank all the hospitals and surgeons whom he met during his stay. The Allura brand is destined to be a revolution in the China market as it heralds a new age for anatomical implants and a more natural appearance.

APS plastic surgery meeting Korea March 2016

The Aesthetic Plastic Surgery meeting in Korea saw an international gathering at the COEX in Seoul from Sat 12th – Sun 13th March 2016. The Korean Society for Aesthetic Plastic Surgery (KSAPS), The Korean Association of Plastic Surgeons (KAPS) and the international societies of China, Japan and the UK joined forces to deliver Koreas premier international meeting for aesthetic plastic surgery.

Mr Ross was invited as a keynote speaker in breast reduction, representing the British Association of Plastic and Reconstructive Aesthetic Surgeons (BAPRAS). This was a highly successful meeting and as a unified group allowed everyone to further our own education to find ways to help our patients.

Thailand, Singapore and Thailand plastic surgery meeting March 2016

Mr Ross was invited to give two talks at the joint Thailand, Singapore, Taiwan (TST) meeting in Thailand (15th – 17th March 2016). He delivered a talk on the Management of Breast Ptosis and One stage Mastopexy Implant and then a talk on breast reconstruction following prophylactic mastectomy. The meeting involved a significant amount of discussion regarding the different techniques employed across the TST regions aiming to improve education and help our patients across the world by the dissemination of information.

 

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Korean Educational Seminar March 2016

Mr Ross was invited to deliver an educational seminar on behalf of Johnson and Johnson looking at the management of Ptosis. The leaders of breast surgery in Korea allowed a healthy debate into the different options and different techniques available. The use and safety of Mentor breast implants were discussed and the importance of choosing an implant with US FDA approval.

 

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Teaching in Asia

Mr Ross was invited on behalf of BAPRAS to attend the 50th Anniversary of the Korean Plastic Surgery Society at the APS meeting in Seoul to speak on Breast Reduction Surgery.

As part of his continuing educational programme with Johnson and Johnson he also hosted a symposium at the APS meeting focused on the management of ptosis and the use of the one stage mastopexy implant technique.

 

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Silimed UKAAPS conference

Mr Ross attended the live masterclass in surgery. The use of polyurethane implants in both the secondary and revisionary setting were demonstrated followed by an upper blepharoplasty and rhinoplasty by Professor Jim Frame. An excellent day hosted by Eurosurgical in conjunction with UKAAPS. This was an incredibly useful event in terms of updating skills and Mr Ross would like to thank Professor Frame and Paul Levick for their time and Eurosurgical and UKAAPS for the opportunity.

 

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