As the International Confederation of Plastic, Reconstructive, and Aesthetic Surgeons (IPRAS) celebrates its 50th Anniversary, it is time to reflect on its history, its activities, and its accomplishments. This will allow IPRAS to re-examine its goals and objectives and restate them in light of IPRASХs role in the world of plastic surgery.

IPRAS began as the solution to the need of the specialty to present the emerging contributions of plastic and reconstructive surgery to the entire world of medicine. IPRAS was formed in 1955 by an international group of plastic surgeons in Sweden in order to bring order and harmonization to an evolving specialty. Men, who became giants in plastic surgery, such as Skoog, Broadbent, Sanvenero-Rosselli, and Manchester, saw the need for an international organization which would provide a forum for the discussion and implementation of scientific advances in plastic surgery. The countries with the largest concentrations of plastic surgeons pledged their support for the concepts envisioned. The first International Symposium was held in Washington, DC and was acknowledged by all plastic surgeons involved to have accomplished the goals anticipated.

In 1992, the emergence of aesthetic surgery as a major sector of plastic surgery prompted IPRAS to add the word ТAestheticУ to its original name, the International Confederation of Plastic and Reconstructive Surgeons (IPRS).

Organization and Governance

IPRAS has grown steadily over the past half century and now is proud of the 91 member countries, representing almost 14,000 plastic surgeons. There are 2 countries which will be added as Provisional Member Countries this year and will be confirmed as Full Members at the next official meeting of the Council of National Delegates. Five additional countries have expressed their interest in joining IPRAS.

The need for regional interaction in plastic surgery led to the formation of Sections within the structure of IPRAS. At present, five Sections represent both geographic and cultural groups throughout the world. They include the European Section (ESPRAS), the Iberolatinamerican Section (FILACP), the Asian-Pacific Section, the PanAfrican Section, and the PanArab Section. These groups host Quadrennial Scientific Congresses on an alternating 4-year cycle.

The governance of IPRAS is patterned on the structure of the United Nations and is designed to provide all countries with the opportunity to participate in its activities. The decision-making body is the Council of National Delegates which is composed of one representative from each of the Full Member nations. The major plastic surgery society or association, which represents all of the qualified plastic surgeons in the country, selects this representative. The Council takes all official actions for IPRAS, selects the next host country for the Quadrennial Congress, and elects the members of the Executive Committee (EXCO) and the General Secretary.

The EXCO manages the affairs of the IPRAS during the 4-year interval between the meetings of the Council of National Delegates. Members of the Council are also charged with the communication of issues affecting plastic surgery between the EXCO and the member national society or association. The Council establishes the dues structure and adopts the budget on the recommendation of the EXCO. All minutes and actions of the EXCO are presented to the Council of National Delegates for ratification at their quadrennial meetings. The General Secretary coordinates the day-to-day management of IPRAS with the assistance of the Executive Secretary and the Secretariat.

The current EXCO has 34 members. Fifteen members represent specific geographic areas of the world. These members are proposed by the Nominating Committee of the EXCO and elected by the Council of National Delegates to a 4-year term. Each of the 5 IPRAS Sections is represented by their respective General Secretary or Coordinator. Special areas of plastic surgical activities are represented by 4 Co-Opted Societies. They are the International Society of Aesthetic Plastic Surgery (ISAPS), the International Society of Craniofacial Surgery (ISCFS), the World Society of Reconstructive Microsurgery (WRMS), and the International Federation of Societies for Surgery of the Hand (IFSSH). The Editor of the on-line newsletter of IPRAS, GLOBALPLAST, and the Chairs and President of the next Quadrennial Congress are appointed to the EXCO. A Deputy Secretary General, a Parliamentarian and a Historian complete the EXCO. The Executive Secretary attends the EXCO in an ex-officio capacity.

In 1992, IPRAS established a not-for-profit foundation, the International Confederation of Plastic, Reconstructive, and Aesthetic Surgery Foundation (IPRAF), to coordinate the educational and humanitarian objectives of plastic surgery. IPRAF is governed by a Board of Directors and coordinated by the Chairman of the Board.

This concentration of plastic surgeons provides the expertise and leadership to allow the EXCO to represent all of the plastic surgeons in the world.

Goals and Objectives

The purpose of IPRAS, as stated in the By-Laws, is to promote the art and science of plastic surgery, to further plastic surgery education and research, and to encourage friendship among plastic surgeons and physicians of all countries.

IPRAS has several major goals that bear restating at its 50year mark, each of which ultimately should result in improvement in the care and treatment of each and every patient entrusting their care to a plastic surgeon. Each goal should be examined in greater detail.

Education

The major educational effort of IPRAS/IPRAF is the Quadrennial Scientific Congress. This Congress provides a venue for plastic surgeons from around the world to bring the fruits of their investigative efforts to the critical arena of their peers. Quadrennial Scientific Congresses have been held in the major centers of plastic surgery around the world with the next Congress scheduled for Berlin, Germany in June 2007. Prospective host countries, under the aegis of an Organizing Committee, bid for the right to host the Congress at the current Congress and the Council of National Delegates selects the winner.

Usually, 800 to 1,000 abstracts are received. The vast majority are accepted to be read in either Plenary Sessions or in smaller, topic-specific sessions. This structure has allowed many of the younger plastic surgeons to present their work and have it critiqued by senior plastic surgeons. Plenary Sessions include Panels that explore current research and technical advances in depth by leaders in the field.

However, another educational effort is a priority for IPRAS/IPRAF. This effort is to bring plastic surgery education to those surgeons working in emerging countries who may not have access to such education otherwise. Small groups of plastic surgical educators visit various countries to provide didactic education and technical training for these surgeons and prospective trainees. Current efforts are being organized for Moldava and Central Africa.

Organizational Assistance

During the past decade, various members of the EXCO, the IPRAF Board, and the Council of National Delegates have visited emerging plastic surgery communities to assist in the organizational development of a national society. The best example of a success is the establishment of the Russian Society of Plastic, Reconstructive and Aesthetic Surgery (RSPRAS). The founding members of this society were drawn from multiple medical disciplines with varying training backgrounds. In a brief decade, RSPRAS has grown to approximately 400 members and has held four biennial Scientific Congresses, which are scientifically solid and organizationally stable. Two other countries have requested similar assistance.

Over the 50 years of IPRASХs existence, changes in the political structure have presented challenges to IPRAS. At this juncture, all of the affected countries, both existing and new, have been incorporated into the IPRAS structure. Appropriate organizational advice has been provided where required.

Quality Assurance

The basic driving concept behind the establishment of IPRAS was to ensure that plastic surgery quality was established around the world. From its inception, IPRAS has been concerned by the incursion of untrained physicians traveling around the world performing operations for which they are not trained. With the advent of global interest in aesthetic surgery, maintenance of standards in plastic surgery is critical. In many countries, membership in IPRAS has been instrumental in convincing governmental bodies that the member plastic surgery society should be the qualifying and certifying organization.

In the European Union, for example, IPRAS has supported and assisted the European Committee for Quality Assurance and Medical Devices in Plastic Surgery (EQUAM) in the quest for rational interpretation of scientific data during the debate over the safety of silicone-gel breast implants. Having the expressed support of an international plastic surgery organization was critically important in the deliberations of the various governmental groups, which made decisions about the availability of the implants. As a corollary, the International Registry of Breast Implants (IBIR) has been supported by IPRAS in organizational and financial needs.

In conclusion, the founding plastic surgeons, who gave birth to IPRAS, were committed to the principle that Тthose who have should provide for those who do not have. This principle continues to guide all of the activities of the leadership of IPRAS/IPRAF.

Albany, New York May, 2005

James G. Hoehn, M.D. General Secretary, IPRAS

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