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Breast Cancer Res Treat. 2018 Dec;172(3):523-537. doi: 10.1007/s10549-018-4937-1. Epub 2018 Sep 4.

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy.

Author information

1
Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. walter.weber@usb.ch.
2
University of Basel, Basel, Switzerland. walter.weber@usb.ch.
3
Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
4
University of Basel, Basel, Switzerland.
5
Department of Gynecology, Medical University of Graz, Graz, Austria.
6
Sektion Senologie, Helios Klinikum Wuppertal GmbH, University Hospital of University Witten/Herdecke, Wuppertal, Germany.
7
Department of Plastic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria.
8
Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
9
Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
10
Breast Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
11
Breast Oncology Division, University of Campinas, Campinas, SP, Brazil.
12
Positivo University Medical School, Curitiba, Brazil.
13
Gynecology and Breast Unit, Goiás Anticancer Association, Hospital Araújo Jorge, Goiânia, Brazil.
14
Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany.
15
Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany.
16
Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany.
17
Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary.
18
Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy.
19
Division of Breast Surgery, European Institute of Oncology, Milan, Italy.
20
Breast Surgery Unit, San Raffaele Hospital, Milan, Italy.
21
Mater Misericordiae University Hospital, Dublin, Ireland.
22
Breast Health Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
23
Department of Surgery, Kaplan Medical Center, Rehovot, Israel.
24
Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.
25
Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain.
26
Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden.
27
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
28
Department of Surgery, Central Hospital, Kristianstad, Sweden.
29
Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland.
30
Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland.
31
Breast Center Zurich, Zurich, Switzerland.
32
Breast Center Thurgau, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
33
Breast Center, Hirslanden Clinic Aarau, Aarau, Switzerland.
34
Institute of Sociology, University of St. Gallen, St. Gallen, Switzerland.
35
Department of Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland.
36
Department of Plastic, Reconstructive and Aesthetic Surgery, Centro di Senologia della Svizzera Italiana (CSSI), Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
37
Breast Center St. Gallen, St. Gallen, Switzerland.
38
Department of Obstetrics and Gynecology, Centro di Senologia della Svizzera Italiana (CSSI), Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
39
Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
40
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
41
Breast Surgery Unit, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
42
Department of Surgery, Royal Liverpool University Hospital, Liverpool, UK.
43
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
44
Department of Surgery, New Victoria Hospital, Glasgow, UK.
45
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
46
Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA.

Abstract

PURPOSE:

Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.

METHODS:

The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.

RESULTS:

Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.

CONCLUSIONS:

In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.

KEYWORDS:

Breast cancer surgery; Immediate breast reconstruction; Nipple-sparing mastectomy

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