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

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 recom-mendations 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

Automated summary

The aim of this article is to discuss the demand for nipple-and skin-sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) and present clinical practice recommendations in the context of expanded indications for post-mastectomy radiation therapy (PMRT). The panel agrees that surgical technique for NSM/SSM should not be modified when PMRT is planned, with preference for autologous over implant-based BR. However, no specific recommendations are made regarding implant positioning, use of mesh or timing. The use of patient-reported outcomes in clinical practice is endorsed. The article emphasizes the importance of prospective randomized phase III studies and interdisciplinary collaboration for determining optimal sequencing and techniques for PMRT in the context of BR.