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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

42 Citations (Scopus)

17 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
DOIs	https://doi.org/10.1016/j.breast.2022.03.008
Publication status	Published - Jun 2022
Publication type	A1 Journal article-refereed

Funding

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

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

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Surgery
Oncology
Cancer Research

Access to Document

10.1016/j.breast.2022.03.008Licence: CC BY

1-s2.0-S0960977622000583-mainFinal published version, 9.99 MBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202206065515Licence: CC BY

Cite this

Weber, W. P., Shaw, J., Pusic, A., Wyld, L., Morrow, M., King, T., Mátrai, Z., Heil, J., Fitzal, F., Potter, S., Rubio, I. T., Cardoso, M. J., Gentilini, O. D., Galimberti, V., Sacchini, V., Rutgers, E. J. T., Benson, J., Allweis, T. M., Haug, M., ... de Boniface, J. (2022). Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy. Breast, 63, 123-139. https://doi.org/10.1016/j.breast.2022.03.008

@article{29f969d1beb043f98ff79549352371cc,

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

author = "Weber, \{Walter Paul\} and Jane Shaw and Andrea Pusic and Lynda Wyld and Monica Morrow and Tari King and Zolt{\'a}n M{\'a}trai and J{\"o}rg Heil and Florian Fitzal and Shelley Potter and Rubio, \{Isabel T.\} and Cardoso, \{Maria Joao\} and Gentilini, \{Oreste Davide\} and Viviana Galimberti and Virgilio Sacchini and Rutgers, \{Emiel J.T.\} and John Benson and Allweis, \{Tanir M.\} and Martin Haug and Paulinelli, \{Regis R.\} and Tibor Kovacs and Yves Harder and Gulluoglu, \{Bahadir M.\} and Eduardo Gonzalez and Andree Faridi and Elisabeth Elder and Peter Dubsky and Blohmer, \{Jens Uwe\} and Vesna Bjelic-Radisic and Mitchel Barry and Hay, \{Susanne Dieroff\} and Kimberly Bowles and James French and Roland Reitsamer and Rupert Koller and Peter Schrenk and Daniela Kauer-Dorner and Jorge Biazus and Fabricio Brenelli and Jaime Letzkus and Ramon Saccilotto and Sarianna Joukainen and Susanna Kauhanen and Ulla Karhunen-Enckell and Juergen Hoffmann and Ulrich Kneser and Thorsten K{\"u}hn and Michalis Kontos and Tampaki, \{Ekaterini Christina\} and Moshe Carmon and Tal Hadar and Giuseppe Catanuto and Garcia-Etienne, \{Carlos A.\} and Linetta Koppert and Gouveia, \{Pedro F.\} and Jakob Lagergren and Tor Svensj{\"o} and Nadia Maggi and Kappos, \{Elisabeth A.\} and Schwab, \{Fabienne D.\} and Liliana Castrezana and Daniel Steffens and Janna Krol and Christoph Tausch and Andreas G{\"u}nthert and Michael Knauer and Katapodi, \{Maria C.\} and Susanne Bucher and Nik Hauser and Christian Kurzeder and Rosine Mucklow and Tsoutsou, \{Pelagia G.\} and Atakan Sezer and {\c C}akmak, \{G{\"u}ldeniz Karadeniz\} and Hasan Karanlik and Patricia Fairbrother and Laszlo Romics and Giacomo Montagna and Cicero Urban and Melanie Walker and Formenti, \{Silvia C.\} and Guenther Gruber and Frank Zimmermann and Zwahlen, \{Daniel Rudolf\} and Sherko Kuemmel and Mahmoud El-Tamer and \{Vrancken Peeters\}, \{Marie Jeanne\} and Orit Kaidar-Person and Michael Gnant and Philip Poortmans and \{de Boniface\}, Jana",

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,

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

language = "English",

volume = "63",

pages = "123--139",

journal = "Breast",

issn = "0960-9776",

publisher = "Churchill Livingstone",

}

Weber, WP, Shaw, J, Pusic, A, Wyld, L, Morrow, M, King, T, Mátrai, Z, Heil, J, Fitzal, F, Potter, S, Rubio, IT, Cardoso, MJ, Gentilini, OD, Galimberti, V, Sacchini, V, Rutgers, EJT, Benson, J, Allweis, TM, Haug, M, Paulinelli, RR, Kovacs, T, Harder, Y, Gulluoglu, BM, Gonzalez, E, Faridi, A, Elder, E, Dubsky, P, Blohmer, JU, Bjelic-Radisic, V, Barry, M, Hay, SD, Bowles, K, French, J, Reitsamer, R, Koller, R, Schrenk, P, Kauer-Dorner, D, Biazus, J, Brenelli, F, Letzkus, J, Saccilotto, R, Joukainen, S, Kauhanen, S, Karhunen-Enckell, U, Hoffmann, J, Kneser, U, Kühn, T, Kontos, M, Tampaki, EC, Carmon, M, Hadar, T, Catanuto, G, Garcia-Etienne, CA, Koppert, L, Gouveia, PF, Lagergren, J, Svensjö, T, Maggi, N, Kappos, EA, Schwab, FD, Castrezana, L, Steffens, D, Krol, J, Tausch, C, Günthert, A, Knauer, M, Katapodi, MC, Bucher, S, Hauser, N, Kurzeder, C, Mucklow, R, Tsoutsou, PG, Sezer, A, Çakmak, GK, Karanlik, H, Fairbrother, P, Romics, L, Montagna, G, Urban, C, Walker, M, Formenti, SC, Gruber, G, Zimmermann, F, Zwahlen, DR, Kuemmel, S, El-Tamer, M, Vrancken Peeters, MJ, Kaidar-Person, O, Gnant, M, Poortmans, P & de Boniface, J 2022, 'Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy', Breast, vol. 63, pp. 123-139. https://doi.org/10.1016/j.breast.2022.03.008

TY - JOUR

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

AU - Weber, Walter Paul

AU - Shaw, Jane

AU - Pusic, Andrea

AU - Wyld, Lynda

AU - Morrow, Monica

AU - King, Tari

AU - Mátrai, Zoltán

AU - Heil, Jörg

AU - Fitzal, Florian

AU - Potter, Shelley

AU - Rubio, Isabel T.

AU - Cardoso, Maria Joao

AU - Gentilini, Oreste Davide

AU - Galimberti, Viviana

AU - Sacchini, Virgilio

AU - Rutgers, Emiel J.T.

AU - Benson, John

AU - Allweis, Tanir M.

AU - Haug, Martin

AU - Paulinelli, Regis R.

AU - Kovacs, Tibor

AU - Harder, Yves

AU - Gulluoglu, Bahadir M.

AU - Gonzalez, Eduardo

AU - Faridi, Andree

AU - Elder, Elisabeth

AU - Dubsky, Peter

AU - Blohmer, Jens Uwe

AU - Bjelic-Radisic, Vesna

AU - Barry, Mitchel

AU - Hay, Susanne Dieroff

AU - Bowles, Kimberly

AU - French, James

AU - Reitsamer, Roland

AU - Koller, Rupert

AU - Schrenk, Peter

AU - Kauer-Dorner, Daniela

AU - Biazus, Jorge

AU - Brenelli, Fabricio

AU - Letzkus, Jaime

AU - Saccilotto, Ramon

AU - Joukainen, Sarianna

AU - Kauhanen, Susanna

AU - Karhunen-Enckell, Ulla

AU - Hoffmann, Juergen

AU - Kneser, Ulrich

AU - Kühn, Thorsten

AU - Kontos, Michalis

AU - Tampaki, Ekaterini Christina

AU - Carmon, Moshe

AU - Hadar, Tal

AU - Catanuto, Giuseppe

AU - Garcia-Etienne, Carlos A.

AU - Koppert, Linetta

AU - Gouveia, Pedro F.

AU - Lagergren, Jakob

AU - Svensjö, Tor

AU - Maggi, Nadia

AU - Kappos, Elisabeth A.

AU - Schwab, Fabienne D.

AU - Castrezana, Liliana

AU - Steffens, Daniel

AU - Krol, Janna

AU - Tausch, Christoph

AU - Günthert, Andreas

AU - Knauer, Michael

AU - Katapodi, Maria C.

AU - Bucher, Susanne

AU - Hauser, Nik

AU - Kurzeder, Christian

AU - Mucklow, Rosine

AU - Tsoutsou, Pelagia G.

AU - Sezer, Atakan

AU - Çakmak, Güldeniz Karadeniz

AU - Karanlik, Hasan

AU - Fairbrother, Patricia

AU - Romics, Laszlo

AU - Montagna, Giacomo

AU - Urban, Cicero

AU - Walker, Melanie

AU - Formenti, Silvia C.

AU - Gruber, Guenther

AU - Zimmermann, Frank

AU - Zwahlen, Daniel Rudolf

AU - Kuemmel, Sherko

AU - El-Tamer, Mahmoud

AU - Vrancken Peeters, Marie Jeanne

AU - Kaidar-Person, Orit

AU - Gnant, Michael

AU - Poortmans, Philip

AU - de Boniface, Jana

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

Y1 - 2022/6

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 - Autologous breast reconstruction

KW - Breast cancer

KW - Implant-based breast reconstruction

KW - Nipple-sparing mastectomy

KW - Post-mastectomy radiotherapy

U2 - 10.1016/j.breast.2022.03.008

DO - 10.1016/j.breast.2022.03.008

M3 - Article

AN - SCOPUS:85127119095

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

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

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