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.
Highlights
The emphasis on esthetic outcomes and quality of life (QoL) after breast cancer treatment has motivated surgeons to develop nipple-sparing mastectomy (NSM) and immediate reconstruction
Consensus recommendations were reached in 35 questions, majority recommendations in 24, and no consensus and no majority in the remaining 12 (Figs. 1, 2, 3, 4, 5, 6 and Supplementary Appendices 4–9)
In the absence of supporting data from clinical studies, recommendations were based on personal opinion or preference [15]
Summary
The emphasis on esthetic outcomes and quality of life (QoL) after breast cancer treatment has motivated surgeons to develop nipple-sparing mastectomy (NSM) and immediate reconstruction. NSM was initially reserved for patients with small tumors, remote from the nipple, based on reports of high rates of nipple involvement in larger tumors [1]. Breast Cancer Research and Treatment (2018) 172:523–537. Even though NSM and immediate reconstruction have been established in routine clinical practice with a supporting evidence base, many questions remain unanswered. The Oncoplastic Breast Consortium (OPBC) consensus conference on NSM was held to address the most urgent questions in clinical practice and research. The goal was to recommend standard surgical approaches pertaining to NSM and reconstruction based on the integration of data from all types of clinical evidence including experience drawn from contemporary practice and innovations in surgery.
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