Scientific publications
Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy
Walter Paul Weber 1 , Jane Shaw 2 , Andrea Pusic 3 , Lynda Wyld 4 , Monica Morrow 5 , Tari King 6 , Zoltán Mátrai 7 , Jörg Heil 8 , Florian Fitzal 9 , Shelley Potter 10 , Isabel T Rubio 11 , Maria-Joao Cardoso 12 , Oreste Davide Gentilini 13 , Viviana Galimberti 14 , Virgilio Sacchini 5 , Emiel J T Rutgers 15 , John Benson 16 , Tanir M Allweis 17 , Martin Haug 18 , Regis R Paulinelli 19 , Tibor Kovacs 20 , Yves Harder 21 , Bahadir M Gulluoglu 22 , Eduardo Gonzalez 23 , Andree Faridi 24 , Elisabeth Elder 25 , Peter Dubsky 26 , Jens-Uwe Blohmer 27 , Vesna Bjelic-Radisic 28 , Mitchel Barry 29 , Susanne Dieroff Hay 30 , Kimberly Bowles 31 , James French 25 , Roland Reitsamer 32 , Rupert Koller 33 , Peter Schrenk 34 , Daniela Kauer-Dorner 35 , Jorge Biazus 36 , Fabricio Brenelli 37 , Jaime Letzkus 38 , Ramon Saccilotto 39 , Sarianna Joukainen 40 , Susanna Kauhanen 41 , Ulla Karhunen-Enckell 42 , Juergen Hoffmann 43 , Ulrich Kneser 44 , Thorsten Kühn 45 , Michalis Kontos 46 , Ekaterini Christina Tampaki 47 , Moshe Carmon 48 , Tal Hadar 17 , Giuseppe Catanuto 49 , Carlos A Garcia-Etienne 50 , Linetta Koppert 51 , Pedro F Gouveia 12 , Jakob Lagergren 52 , Tor Svensjö 53 , Nadia Maggi 54 , Elisabeth A Kappos 18 , Fabienne D Schwab 54 , Liliana Castrezana 54 , Daniel Steffens 54 , Janna Krol 54 , Christoph Tausch 55 , Andreas Günthert 56 , Michael Knauer 57 , Maria C Katapodi 58 , Susanne Bucher 59 , Nik Hauser 60 , Christian Kurzeder 61 , Rosine Mucklow 2 , Pelagia G Tsoutsou 62 , Atakan Sezer 63 , Güldeniz Karadeniz Çakmak 64 , Hasan Karanlik 65 , Patricia Fairbrother 66 , Laszlo Romics 67 , Giacomo Montagna 5 , Cicero Urban 68 , Melanie Walker 69 , Silvia C Formenti 70 , Guenther Gruber 71 , Frank Zimmermann 72 , Daniel Rudolf Zwahlen 73 , Sherko Kuemmel 74 , Mahmoud El-Tamer 5 , Marie Jeanne Vrancken Peeters 75 , Orit Kaidar-Person 76 , Michael Gnant 77 , Philip Poortmans 78 , Jana de Boniface 79
Aim: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
CITA DEL ARTÍCULO Breast. 2022 Jun;63:123-139. doi: 10.1016/j.breast.2022.03.008. Epub 2022 Mar 18
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