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

Walter Weber; Jane Shaw; Andrea Pusic; Lynda Wyld; Monica Morrow; Tari King; Zoltan Matrai; Shelley Potter; et al.

doi:10.1016/j.breast.2022.03.008

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

Walter Weber^*, Jane Shaw, Andrea Pusic, Lynda Wyld, Monica Morrow, Tari King, Zoltan Matrai, Shelley Potter, et al.

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

38 Citations (Scopus)

75 Downloads (Pure)

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

Original language	English
Pages (from-to)	123-139
Number of pages	17
Journal	Breast
Volume	63
Early online date	18 Mar 2022
DOIs	https://doi.org/10.1016/j.breast.2022.03.008
Publication status	Published - 1 Jun 2022

Bibliographical note

Funding Information:
This work was supported by the Department of Surgery of the University Hospital of Basel . The funding source had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding Information:
P. Dubsky received other from Amgen, AstraZeneca, Pfizer, Roche and Merck, grants from Cepheid/Danaher, Agendia, Myriad and from Oncomark.

Publisher Copyright:
© 2022 The Authors

Keywords

Breast cancer
Post-mastectomy radiotherapy
Nipple-sparing mastectomy
Implant-based breast reconstruction
Autologous breast reconstruction

Access to Document

10.1016/j.breast.2022.03.008Licence: CC BY

Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via Elsevier at https://doi.org/10.1016/j.breast.2022.03.008 . Please refer to any applicable terms of use of the publisher
Final published version, 10.1 MBLicence: CC BY

Handle.net

Persistent link

Full Application: The BRIghteR study Breast Reconstruction: InvestigatinG long-term clinical and cost-effectiveness in tHe National MasTectomy and BrEast Reconstruction Audit cohort
Potter, S. (Principal Investigator)
1/04/19 → 23/06/22
Project: Research
The BRAVER Study - Methods to develop less and better research in reconstructive breast surgery
Potter, S. (Principal Investigator)
1/03/17 → 31/08/23
Project: Research

Cite this

@article{e51d76363fa14592a0fd2e9a127b2fe2,

title = "Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy",

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",

keywords = "Breast cancer, Post-mastectomy radiotherapy, Nipple-sparing mastectomy, Implant-based breast reconstruction, Autologous breast reconstruction",

author = "Walter Weber and Jane Shaw and Andrea Pusic and Lynda Wyld and Monica Morrow and Tari King and Zoltan Matrai and Shelley Potter and \{et al.\}",

note = "Funding Information: This work was supported by the Department of Surgery of the University Hospital of Basel . The funding source had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Funding Information: P. Dubsky received other from Amgen, AstraZeneca, Pfizer, Roche and Merck, grants from Cepheid/Danaher, Agendia, Myriad and from Oncomark. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = jun,

day = "1",

doi = "10.1016/j.breast.2022.03.008",

language = "English",

volume = "63",

pages = "123--139",

journal = "Breast",

issn = "0960-9776",

publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

AU - Weber, Walter

AU - Shaw, Jane

AU - Pusic, Andrea

AU - Wyld, Lynda

AU - Morrow, Monica

AU - King, Tari

AU - Matrai, Zoltan

AU - Potter, Shelley

AU - et al.

N1 - Funding Information: This work was supported by the Department of Surgery of the University Hospital of Basel . The funding source had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Funding Information: P. Dubsky received other from Amgen, AstraZeneca, Pfizer, Roche and Merck, grants from Cepheid/Danaher, Agendia, Myriad and from Oncomark. Publisher Copyright: © 2022 The Authors

PY - 2022/6/1

Y1 - 2022/6/1

N2 - 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

AB - 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

KW - Breast cancer

KW - Post-mastectomy radiotherapy

KW - Nipple-sparing mastectomy

KW - Implant-based breast reconstruction

KW - Autologous breast reconstruction

U2 - 10.1016/j.breast.2022.03.008

DO - 10.1016/j.breast.2022.03.008

M3 - Article (Academic Journal)

C2 - 35366506

SN - 0960-9776

VL - 63

SP - 123

EP - 139

JO - Breast

JF - Breast

ER -

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

Abstract

Bibliographical note

Keywords

Access to Document

Handle.net

Fingerprint

Projects

Full Application: The BRIghteR study Breast Reconstruction: InvestigatinG long-term clinical and cost-effectiveness in tHe National MasTectomy and BrEast Reconstruction Audit cohort

The BRAVER Study - Methods to develop less and better research in reconstructive breast surgery

Cite this