Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy.

Apr 4, 2022

Contributor: Walter Paul Weber,Jane Shaw,Andrea Pusic,Lynda Wyld,Monica Morrow,Tari King,Zoltán Mátrai,Jörg Heil,Florian Fitzal,Shelley Potter,Isabel T Rubio,Maria-Joao Cardoso,Oreste Davide Gentilini,Viviana Galimberti,Virgilio Sacchini,Emiel J T Rutgers,John Benson,Tanir M Allweis,Martin Haug,Regis R Paulinelli,Tibor Kovacs,Yves Harder,Bahadir M Gulluoglu,Eduardo Gonzalez,Andree Faridi,Elisabeth Elder,Peter Dubsky,Jens-Uwe Blohmer,Vesna Bjelic-Radisic,Mitchel Barry,Susanne Dieroff Hay,Kimberly Bowles,James French,Roland Reitsamer,Rupert Koller,Peter Schrenk,Daniela Kauer-Dorner,Jorge Biazus,Fabricio Brenelli,Jaime Letzkus,Ramon Saccilotto,Sarianna Joukainen,Susanna Kauhanen,Ulla Karhunen-Enckell,Juergen Hoffmann,Ulrich Kneser,Thorsten Kühn,Michalis Kontos,Ekaterini Christina Tampaki,Moshe Carmon,Tal Hadar,Giuseppe Catanuto,Carlos A Garcia-Etienne,Linetta Koppert,Pedro F Gouveia,Jakob Lagergren,Tor Svensjö,Nadia Maggi,Elisabeth A Kappos,Fabienne D Schwab,Liliana Castrezana,Daniel Steffens,Janna Krol,Christoph Tausch,Andreas Günthert,Michael Knauer,Maria C Katapodi,Susanne Bucher,Nik Hauser,Christian Kurzeder,Rosine Mucklow,Pelagia G Tsoutsou,Atakan Sezer,Güldeniz Karadeniz Çakmak,Hasan Karanlik,Patricia Fairbrother,Laszlo Romics,Giacomo Montagna,Cicero Urban,Melanie Walker,Silvia C Formenti,Guenther Gruber,Frank Zimmermann,Daniel Rudolf Zwahlen,Sherko Kuemmel,Mahmoud El-Tamer,Marie Jeanne Vrancken Peeters,Orit Kaidar-Person,Michael Gnant,Philip Poortmans,Jana de Boniface

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy.

Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario.
A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology.
The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR.
The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

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About The Expert

Walter Paul Weber

Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: walter.weber@usb.ch.

Jane Shaw

Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland.

Andrea Pusic

Brigham and Women’s/Dana Farber Cancer Center, USA.

Lynda Wyld

Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.

Monica Morrow

Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Tari King

Department of Surgery, Brigham and Women’s Hospital / Dana Farber Cancer Institute, USA.

Zoltán Mátrai

Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary.

Jörg Heil

Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany.

Florian Fitzal

Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

Shelley Potter

Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Clifton, Bristol, UK.

Isabel T Rubio

Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain.

Maria-Joao Cardoso

Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal.

Oreste Davide Gentilini

IRCCS Ospedale San Raffaele, Milan, Italy.

Viviana Galimberti

Istituto Europeo di Oncologia, IRCCS, Milan, Italy.

Virgilio Sacchini

Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Emiel J T Rutgers

Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.

John Benson

Cambridge Breast Unit, Addenbrooke’s Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK.

Tanir M Allweis

Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel.

Martin Haug

Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland.

Regis R Paulinelli

Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil.

Tibor Kovacs

Jiahui Internatioonal Hospital Shanghai, China; Guy’s and St. Thomas’ NHS Foundation Trust London, UK.

Yves Harder

Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland.

Bahadir M Gulluoglu

Marmara University School of Medicine, Istanbul, Turkey.

Eduardo Gonzalez

Departament of Mastology, Breast Unit- Instituto de Oncología Angel H Roffo, Buenos Aires Univesity. Buenos Aires, Argentina.

Andree Faridi

Department of Senology/Breast Center, University Hospital Bonn, Germany.

Elisabeth Elder

Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia.

Peter Dubsky

Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland.

Jens-Uwe Blohmer

Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany.

Vesna Bjelic-Radisic

Breast Unit, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany.

Mitchel Barry

Mater Misericordiae University Hospital, Dublin, Ireland.

Susanne Dieroff Hay

Patient Advocacy Group, Oncoplastic Breast Consortium, President, the Swedish Breast Cancer Association, Stockholm, Sweden.

Kimberly Bowles

Patient Advocacy Group, Oncoplastic Breast Consortium, Not Putting on A Shirt, Pittsburgh, USA.

James French

Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia.

Roland Reitsamer

Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.

Rupert Koller

Department of Plastic, Aesthetic and Reconstructive Surgery, Vienna Health Services, Clinic Landstrasse and Clinic Ottakring, Vienna, Austria.

Peter Schrenk

Breast Cancer Center, Kepler University Hospital, Linz, Austria.

Daniela Kauer-Dorner

Department of Radiooncology, University Hospital Vienna, Austria.

Jorge Biazus

Division of Breast Surgery, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.

Fabricio Brenelli

Breast Oncology Division, University of Campinas, Campinas, São Paulo, Brazil.

Jaime Letzkus

San Borja Arriaran Clinical Hospital, University of Chile, Chile.

Ramon Saccilotto

University of Basel, Basel, Switzerland.

Sarianna Joukainen

Kuopio University Hospital, Kuopio, Finland.

Susanna Kauhanen

Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Ulla Karhunen-Enckell

Tampere University Hospital, Department of Surgery and Tays Cancer Center, Tampere, Finland.

Juergen Hoffmann

Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany.

Ulrich Kneser

Department of Hand, Plastic and Reconstructive Surgery – Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany.

Thorsten Kühn

Interdisciplinary Breast Center, Klinikum Esslingen, Germany.

Michalis Kontos

National and Kapodistrian University of Athens, Greece.

Ekaterini Christina Tampaki

Department of Plastic, Reconstructive Surgeryand Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece.

Moshe Carmon

Tel Aviv Soraski Medical Center, Israel.

Tal Hadar

Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel.

Giuseppe Catanuto

Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy.

Carlos A Garcia-Etienne

Breast Unit, Ospedale Santa Chiara, Trento, Italy.

Linetta Koppert

Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.

Pedro F Gouveia

Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal.

Jakob Lagergren

Department of Surgery, Capio St Goran’s Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Tor Svensjö

Department of Surgery, Central Hospital, Kristianstad, Sweden.

Nadia Maggi