Breast cancer surgery Nipple-sparing mastectomy Immediate breast reconstruction
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Weber, W.P. (Walter); Haug, M. (Martin); Kurzeder, C. (Christian); et al. "Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy". Breast cancer research and treatment. 172 (3), 2018, 523 - 537
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.