The annual pilgrimage to Glasgow for the Association of Breast Surgeons Trainees meeting has returned, with breast and plastic trainees and a handful of wonderful trainers from across the country and further afield coming to Glasgow Royal Infirmary for two days. Things kicked off on Tuesday with Henry Cain welcoming us with a fascinating case discussion, highlighting the complex nature of modern breast cancer decision making and the sometimes difficult to manage consequences we face with our patients. Other highlights included Sheila Stallard’s superb review of the key trials that have shaped breast cancer treatment (and which feature heavily in FRCS breast questions!) and Liz Mallon’s very helpful explanation of margin assessment and what we, as surgeons need to understand from the reported numbers.
Live operating video links were interspersed over the two days, including mastopexy augmentation and revision of a previously failed implant-based reconstruction, capsular contracture revisions, lipomodelling to correct significant contour defects, gynaecomastia surgery, symmetrisation surgery, reduction mammoplasty and a nipple reconstruction using a toe based free graft, a first for most of the audience who initially thought the camera was pointing in the wrong direction! The time taken by all of these surgeons to provide context and demonstrate skin markings before knife-to-skin along with the regular updates was greatly appreciated, allowing us to see a wide variety of procedures in a short space of time.
Iain MacPherson talked us through updates from San Antonio and ASCO and presented the advances in genomic profiling of breast cancer, emphasising the need to consider the clinical utility of novel techniques. The challenge in determining which women to offer treatments to, with an acceptable risk and benefit profile was explored and the need to stratify risk and understand tumour biology alongside the potential to cause harm emphasised. Duncan Wheatley presented the scientific background to radiotherapy and helpfully summarised the evidence supporting timing of adjuvant radiotherapy. Rajiv Dave took us through the iBRA2 outcomes, reassuring us that immediate reconstruction was not associated with a delay in starting adjuvant treatment.
Prof Brigid Killelea finished the first day of lectures with an illuminating talk about gender inequality and the pay gap in medicine. The benefits of having a system where no groups are disadvantaged were clear and the need to promote equal opportunities and rewards equally apparent. This talk provoked some interesting discussion. The day concluded in Sloan’s bar in town with a delicious meal followed by a ceilidh and I’m delighted to report the complete absence of any associated injuries.
Day two started with James Mansell’s helpful talk about gynaecomastia, who to investigate and how, which was followed by Duncan Wheatley explaining how we surgeons can decide which of our patients require extended adjuvant treatment and outlining the underpinning evidence. Risk stratification was again a key point, with the need to balance small benefits against the sometimes significant side effect burden of hormone therapies and recognising when it is not appropriate to expose patients to these effects. Alan Redman then explained the subtleties of radiology reporting and what to read into the words used, providing some very helpful insights. How the Manchester unit took up Magseed, both as a novel technique and the process of introducing it safely, was then presented by James Harvey. The Magseed stand was noticeably busier in the break with delegates trying out the technology for themselves.
The morning continued with James Mansell’s talk about preparing for consultant life, encouraging participants to consider not just where they wished to work, but also with whom and doing what. Anne Tansley took us through the 2018 General Surgical Curriculum, as it stands in draft format along with some promising news about the future of breast training in the UK. Prof Mike Dixon finished the lectures with a fascinating journey into the history of and the future of breast cancer surgery, highlighting the importance of a robust understanding of basic sciences, knowledge and careful interpretation of evidence and flexibility in how we deliver care.
The afternoon provided delegates with the opportunity to mark up mammoplasties, LD and perforator flaps and perform ultrasound guided core biopsy with extensive faculty support. The volunteers who very patiently let us peer at, describe, prod and draw on them were a real asset to the course and their willingness to expose themselves for our benefit was greatly appreciated. As the meeting drew to an end people exchanged phone numbers and made plans to keep in touch. Huge thanks must go to Henry and the other organisers for the enormous efforts they have put into making this meeting the success that it is alongside the significant support from both ABS and industry sponsors that made it all possible. The faculty were, as ever, approachable, knowledgeable and inspiring. Looking forward to Glasgow 2019!
By Emma MacInnes