Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Abstract

PurposeIndications 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.MethodsThe 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.ResultsConsensus 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.

Management of early breast cancer during the COVID-19 pandemic in Brazil

“…Breast reconstruction constitutes the basic principle in the present-day surgical treatment of breast cancer, reducing the patient's sensation of mutilation and improving their quality of life [44,45]. Approximately 60% of the participants would recommend total immediate breast reconstruction, with the most commonly suggested technique being de nitive implants, followed by tissue expanders and autologous tissue.…”

Hereditary Gastric and Breast Cancer Syndromes Related to CDH1 Germline Mutation: A Multidisciplinary Clinical Review

“…In terms of oncological safety, the presence of residual breast tissue has raised concerns about this procedure [77]. However, multiple NSM series have been published, and they almost all showed acceptable local recurrence rates [75,78,79]. NSM is also associated with surgical morbidity [75,80], however, in a large series of nearly 2000 consecutive cases from our institution, the rate of nipple necrosis in invasive and in situ cancers was 3.5% and 2.2%, respectively [81], confirming the surgical safety of this technique.…”

The modern approach to the nipple‐sparing mastectomy

“…The breast surgical oncologist determines if oncologic contraindications exist by taking a careful history to elicit symptoms, such as nipple discharge, performing the clinical breast exam, and reviewing all breast imaging and pathology results. Inflammatory breast cancer, clinical signs of nipple involvement, bloody nipple discharge, and a positive retroareolar margin are oncologic contraindications for NSM 11‐13 …”

“…We also mark out the midline using the sternal notch and xiphoid process as landmarks. We then mark the extent of the breast glandular tissue to be removed according to its footprint on the patient's chest wall and anatomical borders 11 …”