Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy
William P. Weber, Jane Shaw, Andrea L. Pusic, Lynda Wyld, Monica Morrow, Tari A. King, Zoltán Mátrai, Jörg Heil, Florian Fitzal, Shelley Potter, Isabel T. Rubio, Maria João Cardoso, Oreste Gentilini, Viviana Galimberti, Virgilio Sacchini, Emiel J. Rutgers, John R. Benson, Tanir M. Allweis, Martin Haug, Régis Resende Paulinelli, Tibor Kovács, Yves Harder, Bahadır M. Güllüoğlu, Eduardo González, Andreé 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 Villanova Biazús, Fabrício Palermo 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 B. Koppert, Pedro Gouveia, Jakob Lagergren, Tor Svensjö, Nadia Maggi, Elisabeth A. Kappos, Fabienne D. Schwab, Liliana Castrezana, Daniel Steffens, Janna Krol, Christoph Tausch, Andreas R. Günthert, Michael Knauer, Maria C. Katapodi, Susanne Bucher, Nik Hauser, Christian Kurzeder, Rosine Mucklow, Pelagia Tsoutsou, Atakan Sezer, Güldeniz Karadeniz Çakmak, Hasan Karanlık, Patricia Fairbrother, Laszlo Romics, Giacomo Montagna, Cı́cero de Andrade Urban, Melanie Walker, Silvia C. Formenti, Guenther Gruber, Frank Zimmermann, Daniel R. Zwahlen, Sherko Küemmel, Mahmoud El‐Tamer, Marie Jeanne Vrancken Peeters, Orit Kaidar‐Person, Michael Gnant, Philip Poortmans, Jana de Boniface
Abstract
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.