Breast (Jun 2022)
Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy
- 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
Affiliations
- Walter Paul Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland; Corresponding author. University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- 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
- Breast Center, University Hospital Basel, Basel, Switzerland
- Elisabeth A. Kappos
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
- Fabienne D. Schwab
- Breast Center, University Hospital Basel, Basel, Switzerland
- Liliana Castrezana
- Breast Center, University Hospital Basel, Basel, Switzerland
- Daniel Steffens
- Breast Center, University Hospital Basel, Basel, Switzerland
- Janna Krol
- Breast Center, University Hospital Basel, Basel, Switzerland
- Christoph Tausch
- Breast Center Zurich, Zurich, Switzerland
- Andreas Günthert
- Gyn-zentrum, Luzern, Switzerland
- Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
- Maria C. Katapodi
- University of Basel, Basel, Switzerland; Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
- Susanne Bucher
- Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Nik Hauser
- Breast Center, Hirslanden Clinic Aarau, Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland
- Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
- Rosine Mucklow
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
- Pelagia G. Tsoutsou
- University Hospital Geneva, University of Geneva, Faculty of Medicine, Geneva, Switzerland
- Atakan Sezer
- Department of Surgery, Trakya University Medical School Hospital, Turkey
- Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
- Hasan Karanlik
- Istanbul University Institute of Oncology, Turkey
- Patricia Fairbrother
- Patient Advocacy Group, Oncoplastic Breast Consortium, Breakthrough Breast Cancer, Association Breast Surgery UKBCC, Kedleston, UK
- Laszlo Romics
- Department of Surgery, New Victoria Hospital, Glasgow, UK
- Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
- Melanie Walker
- Breast Endocrine and General Surgery Unit, The Alfred, Melbourne, Australia; Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Australia
- Silvia C. Formenti
- Department of Radiation Oncology and Meyer Cancer Center, Weill Cornell Medicine, USA
- Guenther Gruber
- Institute for Radiotherapy, Klinik Hirslanden, 8032, Zurich, Switzerland; University of Berne, 3000, Bern, Switzerland
- Frank Zimmermann
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
- Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
- Sherko Kuemmel
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Germany
- Mahmoud El-Tamer
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie Jeanne Vrancken Peeters
- Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands
- Orit Kaidar-Person
- Breast Radiation Therapy Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
- Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
- Journal volume & issue
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Vol. 63
pp. 123 – 139
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
