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Rationale of the Breast Society

Frequently Asked Questions FAQs 

Organization of the Annual Program

Q.        Why do we have a repeat of so much of the same program every year?

A.        The idea behind this organization is that many surgeons need a place to learn how to do cosmetic breast surgery. We want to teach the fundamentals of  breast surgery with any improvements every year.

Like anatomy, many of the basics of cosmetic breast surgery that yield the finest results change very slowly. These changes, such as the new incision site - transumbilical, and the new tissue plane - subfascial  are added as they occur, so we do evolve. But to the person who attends one year after the next, most things seem the same.

Some of the changes that seem to be improvements at first, make us later on want to go back to the tried and true methods that were giving us better results.

Many teaching institutions emphasize the surgery that is considered medically necessary for disease and injury, and purely cosmetic surgery such as breast implants that are done only for cosmetic reasons are not done. Cosmetic surgery that is not done in an institution such as a county hospital is simply not taught.

Many surgeons, who want to learn more about cosmetic surgery and incorporate those techniques into their practice, need a place to go to learn. That need is what this society tries to fill for the surgeons and their patients regarding cosmetic breast surgery. It provides a forum for learning and the give and take discussion and exchange of ideas that are necessary for learning and progress.

Very fine, highly skilled surgeons who have an interest in cosmetic surgery need to have a place to meet surgeons who are doing the type of surgery they want to learn and are experienced and are willing to share their knowledge and experience.

The basic position of this society at this time is that we want to teach the fundamentals of cosmetic breast surgery from the viewpoint of as many experienced surgeons as we can get to share their knowledge. From personal experience after more than 33 years of doing cosmetic breast implant surgery there is still more to learn every year.

Q.        How is the program organized?

A.        The usual program for the first morning is a presentation of the four different incision approaches and the three different tissue planes by different speakers, who more or less prefer and specialize, recommend and have experience in those techniques.

Then that afternoon we discuss complications  - prevention and treatment – and this can go on into the next morning. The next morning is the beginning of the presentations of other procedures such as lifts and reductions.

The evenings are for review of dvds, computer and digital photo techniques, tattoo of visible scars for camouflage, and on the second evening there is the business meeting of the society and other talks.

Sunday is the day for more presentations, a medico legal  seminar, and then anatomy lectures and dissection.

The next days are for observation of surgery in various offices with different techniques being demonstrated.

The anatomy and dissection are very important fir all surgeons. That is where the techniques are best demonstrated and new methods are discovered.

Q.        What advantages are there for someone on the faculty who is already very experienced in breast surgery?

A.        Each person who attends will weigh carefully if there are advantages or not in coming to the meetings.

One distinct advantage to being a welcome member of this faculty, since it is on the fundamentals of breast surgery, is that each year you will have the whole year to get ready for your presentation. The talk you give can be essentially the same as before, but with whatever improvements that can be added.

More information on the Time and Location of the Meetings and how to join the faculty in making a presentation follows the Brief History of the Breast Society below.

 

Brief History of the Breast Society

Q.        How did this breast society get started?

A.        More or less modern breast surgery began in Vienna with the discovery of aseptic technique. In this country for breast diseases it began with planned operations such as William Halstead’s radical mastectomy of the late 1800s for breast cancer.

Jacques Joseph of Berlin  in the late 1800s and early 1900s was one surgeon who was early in reporting on breast lifts and reductions for cosmetic purposes. Dermal fat grafts from the hips and buttocks were placed in the breasts for augmentation. And many filler liquids were injected such as paraffin.

Then in about 1958 a topless dancer, Carol Doda, in  San Francisco had augmentation by silicone injections and appeared in news articles such as Time magazine all over the United States. For the young surgeon coming to California for post graduate study, she held more interest than anything Disneyland had to offer. 

The history of breast implant surgery was begun by Cronin and others in Houston in about 1964.

From then on until the formation of this society in 1985, the way we learned to do breast augmentation surgery was by visiting and studying with the very few surgeons who would share their knowledge. It seemed a good idea to get some sort of course together so that others who wanted to learn this surgery would have more resources for learning.

There was no organization teaching the fundamentals of cosmetic breast surgery and there were no courses available in augmentation or other types of cosmetic breast surgery until this organization was formed. This was brought to the attention of the officers of the American Academy of Cosmetic Surgery in 1984. The majority did not want to teach breast surgery in a course sponsored by the Academy.

Richard Aronsohn, however, who conceived of and organized the Academy when asked said "Don't ever let somebody tell you there is something you can't do." He joined us as a member of the faculty of the first meeting and has attended many meetings since.

The first meeting was in May of 1985. At that first meeting we had an attendance of about a hundred surgeons here in Newport Beach at the Marriott Hotel.

Q.        What other types of courses were available to learn cosmetic surgery?

A.        There were other courses in nose and face work but none in breast cosmetic surgery.

As texts will explain, cosmetic reconstruction of the nose was done with a forehead flap in India as much as two or more thousand years ago. But modern cosmetic surgery of the nose was first done by Roe in America and by Jacque Joseph in Berlin and Harold Gilles in England at the end of the 1800s. Then in Germany and England there was increasing demand for cosmetic and reconstructive surgery  just before, during the time of and after the First World War. There was tremendous advance in cosmetic and reconstructive surgery in reconstructing the wounds to that War, especially of the face by Joseph in Berlin and Sir Harold Gilles (an otorhinolaryngologist) in England.

Joseph and Gilles wrote articles and textbooks and accepted fellow surgeons for training such as Safian, Aufricht, and Foman.  And Gilles’ most famous American student was Ralph Millard. They (Joseph and Gilles) are not known to have taught courses in surgery though.

For pictures and more detailed explanation see http://www.facial-plastic-surgery.org/patient/about_us/h_father.html .

 

 

In this 1922 photograph (left), taken in the office of Professor Friedrich Kopsch in the Anatomical Institute in Berlin, Joseph (seated, at far left) poses with surgeons who came to study his facial plastic techniques. Left to right, seated: Joseph, Kopsch, and an unknown Spanish surgeon. Standing: Jacques Maliniac, Gustave Aufricht, and Zoltan Nagel. Aufricht and another Joseph trainee, Joseph Safian, brought Joseph's rhinoplasty techniques to the New York area in the thirties. (Photo reprinted with permission from W. B. Saunders)

The first courses in America were held by Samuel Foman who became well known as a teacher and who held conferences and taught many others to do nose surgery, such as  Maurice Cottle, Irving Goldman , Ira Tresley and Maury Parkes.

Maurice Cottle was a devoted and excellent teacher and was the principal lecturer of the American Rhinologic Society all through the two decades from the 1950s into the 1970s. Even though he is no longer with us,  that society persisted. It was a fantastic experience for a young surgeron to take the course and get to meet Dr. Cottle and many other of the faculty in 1965. It was eleven days of intensive training including cadaver dissection every afternoon. It was not strictly cosmetic and included functional nose and sinus surgery including a visit with Dr. Takahashi from Japan, whose father’s instrument is still widely used frequently.

The loyal followers of all three men formed societies, and Foman's and Goldman's merged to create the AAFPRS in 1964. (Photos courtesy of Lenore Davis Foman, Pat A. Barelli, and Robert L. Simons)

It was Irving Goldman though who began teaching the Goldman course of rhinoplasty that was almost strictly for cosmetic purposes. At  that course and it was possible to study with Dr. Goldman, Irving Fine, Dr Sidney Fuerstein, Jack Anderson and others of the  faculty. Also there in New York one could meet and observe Dr. Benito Rish, Dr Howard Diamond,  Dr. Aronoff and Dr John Conley.  After the AAFPRS was formed by merging the Otolaryyngologic Plastic Surgery group which included the young Benito Rish with the Goldman course faculty, Dr. Ira Tresley of Chicago and Maury Parkes of Beverly Hills also became frequent faculty members of the group as did Richard Webster, William Wright, Leslie Bernstein and many other excellent teachers.

The AAFPRS has multiple teaching courses every year that are excellent. All  aspects of facial cosmetic surgery are covered.

       Richard B. Aronsohn, M.D., F.A.C.S.

It was in about 1980 that Richard Aronsohn conceived of and started forming the AACS, the American Academy of Cosmetic Surgery. The first meetings in the early 1980s around 1982 and every year thereafter were held in Los Angeles at the Century City hotel. Richard Aronsohn,  Benito Rish, Fred Berkowitz, Bernard Koire, Tom Stephenson, Ron Strahan and many others did breasts and became regular members of the faculty, kindly sharing their knowledge with those who wanted to learn.

At the Century City hotel meeting of the American Academy of Cosmetic Surgery in discussing the formation of a group who were interested in learning and teaching cosmetic breast surgery with other surgeons, there was some objection from those who did not want to see more competition in the field. This was explained to Richard Aronsohn, who had initiated the AACS, and his supportive reply was " Don't ever let someone tell you there is something you can't do." as a matter of principle. He attended the first meeting in 1985 held at the Marriott Hotel in Newport Beach California and many other meetings.

Mel Shiffman also joined the faculty and brought his special knowledge of Surgical Oncology with a specialty in breast cancer and his knowledge and skill as an attorney having graduated with a Juris Doctor degree.

 

Other Information About this Society and the Annual Meetings

Time and Location of the Meetings

Q.        How does one get to give a talk at the society meeting?

A.        Anyone who has something interesting to say should contact the breast society or the president by email or by phone, fax or mail and ask to be on the program. We want as much participation as possible and so it is a good thing to do, and we want everyone to be heard who wants to speak.

If a person was on the faculty and wants to attend and present again, they can expect to do that. Everyone should be allowed to express their views. Any surgeon who is doing breast surgery and wants or is even willing to teach others is welcome to be on the program. Practically everyone is invited back. Some drop out for a year or so and then return and some only come once or twice.

Each meeting is evaluated by the attendees who respond to the CME questionnaire and rate the quality of the meeting and each of the speakers. This information regarding how much the speakers are appreciated by the attendees is evaluated by the society officers. The officers and board of directors have the final say regarding who is invited to be on the program, and that determination is made with respect to the evaluation of the meeting attendees.

The society wants to hear every point of view and from everyone. All are invited to speak and make presentations or to ask questions at the time of the panel discussions or other times.

Q.        Are suggestions for how the meetings can be improved welcome?

A.        Very welcome. Without suggestions and constructive criticism, we cannot improve.

Many of us are there each year to tell essentially all we know, and this changes every year. We do things differently and hopefully with some improvements and better each year.

 

At anytime, the officers and directors will be pleased to hear questions or about problems either by phone, fax or email. All questions will be answered to the best of our ability.

Q.        When is the meeting held each year and why is it not scheduled for the same dates or weekend each year?

A.        The meeting is arranged for the next year at the end of each years meeting. We would like to announce it on the last day of each years meeting. But the problem is that the  hotel has a rule that they cannot schedule us for the next year until our meeting is over. That is because we are a small group compared to others, such as their jazz festival.

Maybe in the future we can be more insistent with the hotel and arrange the next year's meeting so that it can be announced during the meeting rather than after it is over - as was done this last year in 2005.

 

The weekends we try to avoid are the weekends of Memorial day, Mother's day and the last weekend of May which can conflict with many school graduations. May is probably a better month than June partly because school is not yet our.   In early June, school is out and there are many graduation ceremonies and proms as well as weddings and receptions that want to use the hotel.

 

Within a couple of weeks of the end of each year's meeting, and well before July 4th of each year, we will have the dates of the next meeting posted on the web site for everyone to see. This means that reservations and travel arrangements can be scheduled a year in advance.  

 

The program for the next years meeting will also be posted on our web site at ascbs.org for the days of the meeting as soon as those days are chosen. The program is simply the same as last year’s. It is expected to change throughout the year right up to the time of the meeting. But there is no other official program printed.

 

The printed programs we have at the meeting are taken from the program on the internet web site ascbs.org. Every page of that web site has an index at the bottom of the page and there will be listed the links to the last year’s program and the next year’s program.

 

So this year’s program and dates have been available to everyone on the web site at ascbs.org since the end of June 2005 last year. And next year’s program for 2007 will be available by the end of May this year 2006.

 

 Q. Why are the meetings held in the same place every year and why not different places?

A.        Primarily because at any other location we lose the live surgery observation and cadaver dissection.

Each of the past 22 years we have had a meeting here in Newport Beach as well as in four other locations. Those four meetings were held in Las Vegas, Paradise Island in the Bahamas, on Maui in Hawaii, and joined with the AACS in 1994 in Baltimore Maryland.

In 1987 we had a meeting in Las Vegas in addition to the one in Newport. It was at the time of the yearly meeting of the ObGyn surgeons and in the same area of the convention center. Our meeting was only one day and attended only by a few,  but that is where J. Dan Metcalf first joined us.

Subsequently in the late 1980s we had a meeting on Maui in Hawaii and one on Paradise Island next to Nassau in the Bahamas. At both of these meetings the attendance was good, but we could not have the live surgery observation or cadaver dissection that we have here.

The only other meeting not in Newport was a joint meeting with the Academy of Cosmetic Surgery in Baltimore Maryland in 1994. It was a very good meeting and we all got to meet and visit with Jerry Johnson from Houston who developed the fat transplant procedure and invented, developed, published and taught the transumbilical approach. There was no observation of live surgery or cadaver dissection at that meeting in Baltimore, or at any of the meetings we have had other than here in Newport Beach California.

One consideration is that with travel being more available and less expensive than ever before, we can more easily than ever now go to other locations, if that is deemed desirable.  But we still would lose the live surgery observation of different techniques done in different offices and the cadaver dissection.

The set up of the meeting, such as arranging for the meeting with the hotel etc., is considerable. We have audiovisual requirements, such as the digital projector and screens. 

If we had to rent the digital projector for three or four days, it could cost more than our purchase of one. And that is true of a second projector and dvd player etc. as well.  

It is easier to make all the arrangements locally with the same persons than at some other location at a great distance. Here we are working with people who already know our needs.

 

Cadaver dissection can be important to many. And the observation of live surgery in the doctors clinic can be more informative about many details of how what is done is done than just a video or dvd, which usually is limited only to the procedure. We usually have about five surgeons demonstrating their surgery in their own clinics each year here at the meeting.

 

The program for the next years meeting will be posted on our web site at ascbs.org for the days of the meeting as soon as those days are chosen. The program is simply the same as last year’s. It is expected to change throughout the year right up to the time of the meeting. But there is no other official program printed.

 Every page of our asdbs.org web site has an index at the bottom of the page and the links to the last year’s program and the next year’s program will be available usually within two weeks of the end of each years meeting

 

 So this year’s program and dates have been available to everyone on the web site at ascbs.org since the end of June 2007 last year. And next year’s program for 2009 will be available by the end of May this year 2008.

 

 Q.        How many surgeons have learned breast surgery from this society?

 

A.        We have had an average of 30 or so surgeons attend the meetings for the first time since the inception of the course 24 years ago, and more than 800 surgeons have joined as members or fellows. Probably more than a hundred now do more breast surgery than any other procedure in their practice, as opposed to not doing any at all before coming to the meetings and learning from the faculty.

 

Most surgeons who do breast augmentation do many other procedures too, such as face, body and liposuction and sometimes reconstruction of injuries and deformities of many parts of the body and extremities such as the hands.  And yet many of our surgeons who trained with us and are members of our faculty essentially specialize in cosmetic breast surgery and do many more times the number of breast procedures than the average surgeon. And therefore, I expect that those who are or have been affiliated with this organization do as much as ten percent of the total breast implant surgery that is done here in this country.

 

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The American Society of Cosmetic Breast Surgery 2017    Last modified: June 23, 2017