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Review
. 2018 Dec;172(3):523-537.
doi: 10.1007/s10549-018-4937-1. Epub 2018 Sep 4.

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Walter P Weber  1   2 , Martin Haug  3   4 , Christian Kurzeder  3   4 , Vesna Bjelic-Radisic  5   6 , Rupert Koller  7 , Roland Reitsamer  8 , Florian Fitzal  9 , Jorge Biazus  10 , Fabricio Brenelli  11 , Cicero Urban  12 , Régis Resende Paulinelli  13 , Jens-Uwe Blohmer  14 , Jörg Heil  15 , Jürgen Hoffmann  16 , Zoltan Matrai  17 , Giuseppe Catanuto  18 , Viviana Galimberti  19 , Oreste Gentilini  20 , Mitchel Barry  21 , Tal Hadar  22 , Tanir M Allweis  23 , Oded Olsha  22 , Maria João Cardoso  24 , Pedro F Gouveia  24 , Isabel T Rubio  25 , Jana de Boniface  26   27 , Tor Svensjö  28 , Susanne Bucher  29 , Peter Dubsky  9   30 , Jian Farhadi  31 , Mathias K Fehr  32 , Ilario Fulco  3   4   33 , Ursula Ganz-Blättler  34 , Andreas Günthert  35 , Yves Harder  36 , Nik Hauser  33 , Elisabeth A Kappos  3   4 , Michael Knauer  37 , Julia Landin  3   4 , Robert Mechera  3   4 , Francesco Meani  38 , Giacomo Montagna  3   4 , Mathilde Ritter  3   4 , Ramon Saccilotto  4   39 , Fabienne D Schwab  3   4 , Daniel Steffens  3   4 , Christoph Tausch  31 , Jasmin Zeindler  3   4 , Savas D Soysal  3   4 , Visnu Lohsiriwat  40 , Tibor Kovacs  41 , Anne Tansley  42 , Lynda Wyld  43 , Laszlo Romics  44 , Mahmoud El-Tamer  45 , Andrea L Pusic  46 , Virgilio Sacchini  45 , Michael Gnant  9
Affiliations
Review

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Walter P Weber et al. Breast Cancer Res Treat. 2018 Dec.

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.

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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
See this image and copyright information in PMC

References

    1. Cense HA, Rutgers EJ, Cardozo ML, Van Lanschot JJ. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol. 2001;27(6):521–526. doi: 10.1053/ejso.2001.1130. - DOI - PubMed
    1. Peled AW, Wang F, Foster RD, et al. Expanding the indications for total skin-sparing mastectomy: is it safe for patients with locally advanced disease? Ann Surg Oncol. 2016;23(1):87–91. doi: 10.1245/s10434-015-4734-6. - DOI - PubMed
    1. Sisco M, Kyrillos AM, Lapin BR, Wang CE, Yao KA. Trends and variation in the use of nipple-sparing mastectomy for breast cancer in the United States. Breast Cancer Res Treat. 2016;160(1):111–120. doi: 10.1007/s10549-016-3975-9. - DOI - PubMed
    1. Jakub JW, Peled AW, Gray RJ, et al. Oncologic safety of prophylactic nipple-sparing mastectomy in a population with BRCA mutations: a multi-institutional study. JAMA Surg. 2018;153(2):123–129. doi: 10.1001/jamasurg.2017.3422. - DOI - PMC - PubMed
    1. Yao K, Liederbach E, Tang R, et al. Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol. 2015;22(2):370–376. doi: 10.1245/s10434-014-3883-3. - DOI - PubMed