Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy
Walter P Weber 1 2 , Martin Haug 3 4 , Christian Kurzeder 3 4 , Vesna Bjelic-Radisic 5 6 , Rupert Koller 7 , Roland Reitsamer 8 , Florian Fitzal 9 , Jorge Biazus 10 , Fabricio Brenelli 11 , Cicero Urban 12 , Régis Resende Paulinelli 13 , Jens-Uwe Blohmer 14 , Jörg Heil 15 , Jürgen Hoffmann 16 , Zoltan Matrai 17 , Giuseppe Catanuto 18 , Viviana Galimberti 19 , Oreste Gentilini 20 , Mitchel Barry 21 , Tal Hadar 22 , Tanir M Allweis 23 , Oded Olsha 22 , Maria João Cardoso 24 , Pedro F Gouveia 24 , Isabel T Rubio 25 , Jana de Boniface 26 27 , Tor Svensjö 28 , Susanne Bucher 29 , Peter Dubsky 9 30 , Jian Farhadi 31 , Mathias K Fehr 32 , Ilario Fulco 3 4 33 , Ursula Ganz-Blättler 34 , Andreas Günthert 35 , Yves Harder 36 , Nik Hauser 33 , Elisabeth A Kappos 3 4 , Michael Knauer 37 , Julia Landin 3 4 , Robert Mechera 3 4 , Francesco Meani 38 , Giacomo Montagna 3 4 , Mathilde Ritter 3 4 , Ramon Saccilotto 4 39 , Fabienne D Schwab 3 4 , Daniel Steffens 3 4 , Christoph Tausch 31 , Jasmin Zeindler 3 4 , Savas D Soysal 3 4 , Visnu Lohsiriwat 40 , Tibor Kovacs 41 , Anne Tansley 42 , Lynda Wyld 43 , Laszlo Romics 44 , Mahmoud El-Tamer 45 , Andrea L Pusic 46 , Virgilio Sacchini 45 , Michael Gnant 9
Purpose: Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.
Methods: The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.
Results: Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.
Conclusions: In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.