Royal Australasian College of Surgeons, Annual Scientific Congress, Perth, May 2010.

Formed in 1927, the Royal Australasian College of Surgeons (RACS) is an internationally recognised organisation for 7,100 surgeons based mainly in Australia and New Zealand. The RACS Annual Scientific Congress (ASC) is the largest annual multi-disciplinary surgical meeting held in Australasia and each year attracts over 2,000 registrants comprising surgeons and other health professionals.

The 2010 ASC, held in Perth, featured more than 20 scientific programs encompassing all major surgical specialties. All sections invite one or more leading international or Australasian visitor to participate in their program which features plenary sessions, concurrent presentations of scientific papers, prestigious named lectures, electronic posters, masterclasses and workshops.

A Breast Masterclass held on ‘Oncoplastic techniques: breast reduction and mastopexy’ was very well attended, especially given the 7am scheduling, reflecting great interest in this field.

The Breast Surgery Section international visitor, Professor Henry Kuerer, Professor of Surgery at M. D. Anderson Cancer Centre, Houston, USA, spoke on “The Role and Technique of Nipple-areolar and Skin Sparing Mastectomy”. In skin-sparing mastectomy, the entire breast and the nipple/areola complex are removed, without removal of the remaining breast skin. The surrounding skin remains intact, creating a pocket that allows reconstruction to take place.This technique preserves the skin of the breast, but not the nipple and areola.

According to Prof Kuerer, “skin sparing” mastectomy (SSM) is an oncologically safe, psychologically beneficial option for women undergoing mastectomy for risk reduction or for treatment of breast cancer. Multiple studies have now demonstrated the oncologic safety, acceptable major complication rate and good to excellent patient satisfaction associated with skin-sparing mastectomy.

There have now also been several series that have reported on the outcome of “nipple-sparing” mastectomy (NSM). This procedure, also known as total skin sparing mastectomy or subcutaneous mastectomy, not only preserves the skin of the breast, but also the nipple/ areola complex. Nipple sensation following NSM, as reported in the literature, is variable and the nipple often loses erectile function. Despite this, many patients prefer the idea of preserving this portion of the breast. Skin and especially nipple- sparing mastectomy are technically demanding operations which are being performed through smaller and smaller incisions. One concern of nipple- sparing mastectomy is that the nipple itself has been reported in modern day literature to harbor carcinoma in about 10% of patients. Therefore, it is essential to perform frozen-section of the internal nipple core at the time of surgery and resect the nipple if there is any tumor involvement.

The Epworth Breast Service team (pictured above) travelled west together for the conference and enjoyed the fine Perth weather and scenery.