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

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

Breast. 2022 Jun:63:123-139. doi: 10.1016/j.breast.2022.03.008. Epub 2022 Mar 18.

Authors

Walter Paul Weber¹, Jane Shaw², Andrea Pusic³, Lynda Wyld⁴, Monica Morrow⁵, Tari King⁶, Zoltán Mátrai⁷, Jörg Heil⁸, Florian Fitzal⁹, Shelley Potter¹⁰, Isabel T Rubio¹¹, Maria-Joao Cardoso¹², Oreste Davide Gentilini¹³, Viviana Galimberti¹⁴, Virgilio Sacchini⁵, Emiel J T Rutgers¹⁵, John Benson¹⁶, Tanir M Allweis¹⁷, Martin Haug¹⁸, Regis R Paulinelli¹⁹, Tibor Kovacs²⁰, Yves Harder²¹, Bahadir M Gulluoglu²², Eduardo Gonzalez²³, Andree Faridi²⁴, Elisabeth Elder²⁵, Peter Dubsky²⁶, Jens-Uwe Blohmer²⁷, Vesna Bjelic-Radisic²⁸, Mitchel Barry²⁹, Susanne Dieroff Hay³⁰, Kimberly Bowles³¹, James French²⁵, Roland Reitsamer³², Rupert Koller³³, Peter Schrenk³⁴, Daniela Kauer-Dorner³⁵, Jorge Biazus³⁶, Fabricio Brenelli³⁷, Jaime Letzkus³⁸, Ramon Saccilotto³⁹, Sarianna Joukainen⁴⁰, Susanna Kauhanen⁴¹, Ulla Karhunen-Enckell⁴², Juergen Hoffmann⁴³, Ulrich Kneser⁴⁴, Thorsten Kühn⁴⁵, Michalis Kontos⁴⁶, Ekaterini Christina Tampaki⁴⁷, Moshe Carmon⁴⁸, Tal Hadar¹⁷, Giuseppe Catanuto⁴⁹, Carlos A Garcia-Etienne⁵⁰, Linetta Koppert⁵¹, Pedro F Gouveia¹², Jakob Lagergren⁵², Tor Svensjö⁵³, Nadia Maggi⁵⁴, Elisabeth A Kappos¹⁸, Fabienne D Schwab⁵⁴, Liliana Castrezana⁵⁴, Daniel Steffens⁵⁴, Janna Krol⁵⁴, Christoph Tausch⁵⁵, Andreas Günthert⁵⁶, Michael Knauer⁵⁷, Maria C Katapodi⁵⁸, Susanne Bucher⁵⁹, Nik Hauser⁶⁰, Christian Kurzeder⁶¹, Rosine Mucklow², Pelagia G Tsoutsou⁶², Atakan Sezer⁶³, Güldeniz Karadeniz Çakmak⁶⁴, Hasan Karanlik⁶⁵, Patricia Fairbrother⁶⁶, Laszlo Romics⁶⁷, Giacomo Montagna⁵, Cicero Urban⁶⁸, Melanie Walker⁶⁹, Silvia C Formenti⁷⁰, Guenther Gruber⁷¹, Frank Zimmermann⁷², Daniel Rudolf Zwahlen⁷³, Sherko Kuemmel⁷⁴, Mahmoud El-Tamer⁵, Marie Jeanne Vrancken Peeters⁷⁵, Orit Kaidar-Person⁷⁶, Michael Gnant⁷⁷, Philip Poortmans⁷⁸, Jana de Boniface⁷⁹

Affiliations

¹ Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: [email protected].
² Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland.
³ Brigham and Women's/Dana Farber Cancer Center, USA.
⁴ Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
⁵ Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁶ Department of Surgery, Brigham and Women's Hospital / Dana Farber Cancer Institute, USA.
⁷ Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary.
⁸ Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany.
⁹ Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁰ Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Clifton, Bristol, UK.
¹¹ Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain.
¹² Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal.
¹³ IRCCS Ospedale San Raffaele, Milan, Italy.
¹⁴ Istituto Europeo di Oncologia, IRCCS, Milan, Italy.
¹⁵ Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
¹⁶ 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.
¹⁷ Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel.
¹⁸ Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁹ Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil.
²⁰ Jiahui Internatioonal Hospital Shanghai, China; Guy's and St. Thomas' NHS Foundation Trust London, UK.
²¹ 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.
²² Marmara University School of Medicine, Istanbul, Turkey.
²³ Departament of Mastology, Breast Unit- Instituto de Oncología Angel H Roffo, Buenos Aires Univesity. Buenos Aires, Argentina.
²⁴ Department of Senology/Breast Center, University Hospital Bonn, Germany.
²⁵ Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia.
²⁶ Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland.
²⁷ Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany.
²⁸ Breast Unit, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany.
²⁹ Mater Misericordiae University Hospital, Dublin, Ireland.
³⁰ Patient Advocacy Group, Oncoplastic Breast Consortium, President, the Swedish Breast Cancer Association, Stockholm, Sweden.
³¹ Patient Advocacy Group, Oncoplastic Breast Consortium, Not Putting on A Shirt, Pittsburgh, USA.
³² Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
³³ Department of Plastic, Aesthetic and Reconstructive Surgery, Vienna Health Services, Clinic Landstrasse and Clinic Ottakring, Vienna, Austria.
³⁴ Breast Cancer Center, Kepler University Hospital, Linz, Austria.
³⁵ Department of Radiooncology, University Hospital Vienna, Austria.
³⁶ Division of Breast Surgery, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
³⁷ Breast Oncology Division, University of Campinas, Campinas, São Paulo, Brazil.
³⁸ San Borja Arriaran Clinical Hospital, University of Chile, Chile.
³⁹ University of Basel, Basel, Switzerland.
⁴⁰ Kuopio University Hospital, Kuopio, Finland.
⁴¹ Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁴² Tampere University Hospital, Department of Surgery and Tays Cancer Center, Tampere, Finland.
⁴³ Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany.
⁴⁴ Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany.
⁴⁵ Interdisciplinary Breast Center, Klinikum Esslingen, Germany.
⁴⁶ National and Kapodistrian University of Athens, Greece.
⁴⁷ Department of Plastic, Reconstructive Surgeryand Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece.
⁴⁸ Tel Aviv Soraski Medical Center, Israel.
⁴⁹ Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy.
⁵⁰ Breast Unit, Ospedale Santa Chiara, Trento, Italy.
⁵¹ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁵² Department of Surgery, Capio St Goran's Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
⁵³ Department of Surgery, Central Hospital, Kristianstad, Sweden.
⁵⁴ Breast Center, University Hospital Basel, Basel, Switzerland.
⁵⁵ Breast Center Zurich, Zurich, Switzerland.
⁵⁶ Gyn-zentrum, Luzern, Switzerland.
⁵⁷ Breast Center Eastern Switzerland, St. Gallen, Switzerland.
⁵⁸ University of Basel, Basel, Switzerland; Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland.
⁵⁹ Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland.
⁶⁰ Breast Center, Hirslanden Clinic Aarau, Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland.
⁶¹ Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
⁶² University Hospital Geneva, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
⁶³ Department of Surgery, Trakya University Medical School Hospital, Turkey.
⁶⁴ Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
⁶⁵ Istanbul University Institute of Oncology, Turkey.
⁶⁶ Patient Advocacy Group, Oncoplastic Breast Consortium, Breakthrough Breast Cancer, Association Breast Surgery UKBCC, Kedleston, UK.
⁶⁷ Department of Surgery, New Victoria Hospital, Glasgow, UK.
⁶⁸ Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil.
⁶⁹ Breast Endocrine and General Surgery Unit, The Alfred, Melbourne, Australia; Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Australia.
⁷⁰ Department of Radiation Oncology and Meyer Cancer Center, Weill Cornell Medicine, USA.
⁷¹ Institute for Radiotherapy, Klinik Hirslanden, 8032, Zurich, Switzerland; University of Berne, 3000, Bern, Switzerland.
⁷² Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland.
⁷³ Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
⁷⁴ Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Germany.
⁷⁵ Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands.
⁷⁶ Breast Radiation Therapy Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
⁷⁷ Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
⁷⁸ Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium.
⁷⁹ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden.

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

MeSH terms

Breast Neoplasms* / radiotherapy
Breast Neoplasms* / surgery
Female
Humans
Mammaplasty* / methods
Mastectomy / methods
Nipples
Prospective Studies