Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland.
Breast. 2022 Jun;63:123-139. doi: 10.1016/j.breast.2022.03.008. Epub 2022 Mar 18.
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.
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.
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 recommendations 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.
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.
随着保乳术后放疗（PMRT）适应证的扩大，对保留乳头和皮肤的乳房切除术（NSM/SSM）联合即刻乳房重建（BR）的需求也有所增加。Oncoplastic Breast Consortium 倡议的目的是解决这一具有临床挑战性的方案所带来的相关问题。
一个由肿瘤学、肿瘤整形和重建乳房外科医生、患者权益倡导者和放射肿瘤学家组成的大型全球小组，根据 Delphi 方法学的原则，通过迭代过程制定了临床实践建议。
专家组一致认为，当计划进行 PMRT 时，不应对 NSM/SSM 的手术技术进行正式修改，因为与基于植入物的 BR 相比，自体 BR 的长期并发症风险更低，并且支持即刻和延迟即刻重建方法。然而，强烈认为 PMRT 不是植入物或其他类型 BR 的绝对禁忌证，但由于缺乏高质量证据，未针对植入物定位、使用网片或时机提出具体建议。专家组支持在临床实践中使用患者报告的结果。人们认识到，重建乳房的形状和大小可能会阻碍放疗计划，并且需要注意 PMRT 技术的细节，以确定即刻 BR 后的美学效果。
专家组认可需要前瞻性的、理想的随机 III 期研究，以及外科和放射肿瘤学团队共同努力，为每位接受 BR 的患者确定 PMRT 的最佳顺序和技术。
