Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Walter P Weber, Martin Haug, Christian Kurzeder, Vesna Bjelic-Radisic, Rupert Koller, Roland Reitsamer, Florian Fitzal, Jorge Biazus, Fabricio Brenelli, Cicero Urban, Régis Resende Paulinelli, Jens-Uwe Blohmer, Jörg Heil, Jürgen Hoffmann, Zoltan Matrai, Giuseppe Catanuto, Viviana Galimberti, Oreste Gentilini, Mitchel Barry, Tal Hadar, Tanir M Allweis, Oded Olsha, Maria João Cardoso, Pedro F Gouveia, Isabel T Rubio, Jana de Boniface, Tor Svensjö, Susanne Bucher, Peter Dubsky, Jian Farhadi, Mathias K Fehr, Ilario Fulco, Ursula Ganz-Blättler, Andreas Günthert, Yves Harder, Nik Hauser, Elisabeth A Kappos, Michael Knauer, Julia Landin, Robert Mechera, Francesco Meani, Giacomo Montagna, Mathilde Ritter, Ramon Saccilotto, Fabienne D Schwab, Daniel Steffens, Christoph Tausch, Jasmin Zeindler, Savas D Soysal, Visnu Lohsiriwat, Tibor Kovacs, Anne Tansley, Lynda Wyld, Laszlo Romics, Mahmoud El-Tamer, Andrea L Pusic, Virgilio Sacchini, Michael Gnant, Walter P Weber, Martin Haug, Christian Kurzeder, Vesna Bjelic-Radisic, Rupert Koller, Roland Reitsamer, Florian Fitzal, Jorge Biazus, Fabricio Brenelli, Cicero Urban, Régis Resende Paulinelli, Jens-Uwe Blohmer, Jörg Heil, Jürgen Hoffmann, Zoltan Matrai, Giuseppe Catanuto, Viviana Galimberti, Oreste Gentilini, Mitchel Barry, Tal Hadar, Tanir M Allweis, Oded Olsha, Maria João Cardoso, Pedro F Gouveia, Isabel T Rubio, Jana de Boniface, Tor Svensjö, Susanne Bucher, Peter Dubsky, Jian Farhadi, Mathias K Fehr, Ilario Fulco, Ursula Ganz-Blättler, Andreas Günthert, Yves Harder, Nik Hauser, Elisabeth A Kappos, Michael Knauer, Julia Landin, Robert Mechera, Francesco Meani, Giacomo Montagna, Mathilde Ritter, Ramon Saccilotto, Fabienne D Schwab, Daniel Steffens, Christoph Tausch, Jasmin Zeindler, Savas D Soysal, Visnu Lohsiriwat, Tibor Kovacs, Anne Tansley, Lynda Wyld, Laszlo Romics, Mahmoud El-Tamer, Andrea L Pusic, Virgilio Sacchini, Michael Gnant

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.

Conflict of interest statement

Dr. Gnant reports grants from AstraZeneca, Novartis, Pfizer and Roche, as well as personal fees from Accelsiors, Amgen, AstraZeneca, Celgene, Elli Lilly, Ipsen, Nano String Technologies, Novartis, Pfizer and Roche. Dr. Hadar reports reimbursement of travel expenses by Medison and Roche. Dr. Pusic is a co-developer of BREAST-Q, FACE-Q and BODY-Q, which are owned by Memorial Sloan-Kettering Cancer Center; she receives license fee payments for the use of BREAST-Q, FACE-Q and BODY-Q in industry-sponsored clinical trials. Dr Fitzal reports grants and advisory board as well as meeting support by Pfizer, Novartis, Astra Zeneca, Roche, Comesa, Bondimed. Dr. Saccilotto reports personal fees from the Oncoplastic Breast Consortium during the conduct of the study. All other authors report no competing interests.

Figures

Fig. 1
Fig. 1
Consensus conference results: standardization, oncological safety and indications
Fig. 2
Fig. 2
Consensus conference results: surgical technique
Fig. 3
Fig. 3
Consensus conference results: contraindications
Fig. 4
Fig. 4
Consensus conference results: special considerations in the risk reducing and therapeutic setting
Fig. 5
Fig. 5
Consensus conference results: breast reconstruction
Fig. 6
Fig. 6
Consensus conference results: registries and outcome assessment

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