Journal
BREAST CANCER RESEARCH AND TREATMENT
Volume 172, Issue 3, Pages 523-537Publisher
SPRINGER
DOI: 10.1007/s10549-018-4937-1
Keywords
Breast cancer surgery; Nipple-sparing mastectomy; Immediate breast reconstruction
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Funding
- Swiss Cancer League
- Swiss Cancer Research Foundation
- Claudia von Schilling Foundation for Breast Cancer Research
- Sandoz
- Roche
- University Hospital Basel
- Kiechle Orthopadie Technik
- NATIONAL CANCER INSTITUTE [P30CA008748] Funding Source: NIH RePORTER
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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.
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