in der dkg e.v. oncoplastic and - ago- · pdf fileversion 2015.1 oncoplastic and...
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Diagnosis and Treatment of Patients with
Primary and Metastatic Breast Cancer
© AGO e. V. in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2015.1 Oncoplastic and
Reconstructive Surgery
© AGO e. V. in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Versions 2002–2014:
Audretsch / Blohmer / Brunnert / Dall /
Fersis / Hanf / Kümmel / Lux / Nitz / Rezai /
Rody / Scharl / Thomssen
Version 2015:
Bauerfeind / Brunnert
Oncoplastic and Reconstructive
Surgery
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Definition of Oncoplastic Surgery
Use of plastic surgical techniques at the time of tumor excision to
enable safe resection margins and to preserve aesthetic breast
contour.
Oncoplastic surgery reduces the number of reexcisions,
increases the number of BCTs and leads to high patient
satisfaction.
© AGO e. V. in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Oncoplastic Breast Conserving Surgery
Reduction mammaplasty 2a B +
Mastopexy techniques 3a B +
Oncoplastic flap techniques 2a B +
Partial mastectomy
with tissue transfer 3b B +
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Algorithm of Breast Reconstruction
Implant alone not suitable –
hostile environment
LADO + implant
if not suitable
Consider implant + additional acellular
matrix and / or fat grafting
if both not suitable
Microsurgery/free flaps
TRAM-Flap or
1st choice:
Implant-Reconstruction
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Use of silicone filled breast implants 2a B +
Autologous tissue reconstruction 2a B +
Pedicled tissue reconstruction 2a B +
Free tissue reconstruction 2a B +
Autologous tissue combined with implants 3a C +
Oxford / AGO
LoE / GR
Postmastectomy Reconstruction
Attention: BMI >30, smoking status, Diabetes, RT, age
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Delayed BR 3b B ++
No interference with adjuvant
procedures (CHT, RT)
Disadvantage: loss of skin envelope
Immediate BR 3b B ++
Mandatory: SSM / NSM
Avoidance of a postmastectomy syndrome
„Delayed-immediate“ BR 3b B +/-
Timing of Reconstruction
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Implant reconstruction (IR) 2a B +
IR without radiotherapy (RT) 2a B ++
IR following MX and RT 2b B +/-
IR prior to RT / following PBRT
(higher complication rate) 2a B +
IR following Mx for local relapse after
BCT 2a B +/-
Periop. antibiotic therapy (at least 48 h) 3b C +
Oxford / AGO
LoE / GR
Timing of Postmastectomy Implant
Reconstruction
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Autologous tissue (e.g. LDF*) 3b C +#
Acellular dermal matrix (ADM) 2b B +#
Synthetic mesh 2b B +#
* LDF = Latissimus dorsi flap
# Participation in register studies recommended
Oxford / AGO
LoE / GR
Soft Tissue Replacement Techniques
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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Lipotransfer
Lipotransfer after MX and breast
reconstruction 2a B +
Lipotransfer after breast-conserving
therapy 4 D +/-
Autologous adipose derived stem cells
(ASCs)-enriched fat grafts 5 D -
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Reconstruction (BR) with autologous tissue
TRAM, latissimus-dorsi-flap (both can be
performed as a muscle-sparing technique) 3b C +
Delayed TRAM in risk patients 3a B +
Ipsilateral pedicled TRAM 3b A +
Radiotherapy:
BR following RT 2 a B +
BR prior to RT 2a B +/-
(more fibrosis, more wound healing problems,
more liponecrosis)
Oxford / AGO
LoE / GR
Postmastectomy Pedicled
Reconstruction
© AGO e. V. in der DGGG e.V.
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Guidelines Breast
Version 2015.1
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Free tissue transfer
Free TRAM-flap 3a B +/-
DIEP-flap 3a B +
SIEA-flap 3a C +/-
SGAP- / IGAP-flap 4 C +/-
Free gracilis flap (TMG) 4 C +/-
Advantage:
Free TRAM, DIEP are potentially muscle-sparing procedures. The DIEP has a lower rate of abdominal hernias.
Disadvantages: Time- and personnel-consuming microsurgical procedure
Intensified postoperative monitoring
Higher rate of re-operations
Higher total failure rate
Pre-reconstruction RT increases rate of vascular complications
No higher patient satisfaction than with pedicled TRAM in multivariate analysis
Free Tissue Transfer
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
Muscle-sparing techniques and accuracy
of abdominal wall closure will lead to low
rates of late donor site complications
whatever method used 3a A ++
Autologous abdominal-based reconstructions
have the highest satisfaction in all patient
groups without any difference
Perforator flaps appear to have a higher risk
for fat necrosis than free or pedicle TRAM
Donor site morbidity (e.g. impaired muscle
function) has to be taken into
consideration in all flap techniques
Pedicled vs. Free Tissue Transfer
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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Flap-implant combination
LDF* + implant 2b C +
IR following RT 3b C +
IR prior to RT 5 D -
Advantages:
TRAM: staged procedure preferable
Improved implant coverage
Suitable for radiated tissue
Disadvantage:
Muscle contraction (LDF)
* LDF = Latissimus dorsi flap
Flap-Implant Combination
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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Skin sparing mastectomy (SSM/NSM)
Safe (same recurrence rate as MX) 2b B ++
Higher QoL for patients 2b B ++
NAC can be preserved under special conditions 2b B ++
Feasible after mastopexy / reduction mammoplasty 4 C ++
Skin incisions different options possible:
Periareolar („purse-string“) (higher risk of necrosis)
Reduction pattern: „inverted-T“ or vertical
Inferior lateral approach, inframammary fold
Lowest incidence of complications 2b B +
Skin/Nipple Sparing Mastectomy (SSM/NSM)
and Reconstruction
Oxford / AGO
LoE / GR
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
www.ago-online.de
RRBM reduces breast cancer incidence 1b A ++
RRBM in deleterious BRCA1/2 mutation 2a B +*
RRBM in high risk (i.e. lifetime risk >=30% or
heterozygote risk >=20%) but index case
negative for BRCA1/2 mutations 3a C +/-*
High risk and no BRCA counselling
in specialized centre* 5 D - -
Non-directive counselling prior to RRBM 2b B ++*
RRBM should be considered with other
prophylactic surgical options
incl. salpingoophorectomy (BSO) 2a A ++*
Further need for education of physicians regarding 1b A ++
possibilities and advantages of RRBM
Bilateral Risk Reducing Mastectomy
in Healthy Women (RRBM)
Oxford / AGO
LoE / GR
* Study participation recommended •*Counselling, risk prediction and follow-up in
specialised centres recommended
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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Risk Reducing Mastectomy
reduces breast cancer incidence;
bc-spec mortality reduction likely
Simple mastectomy 2b B +
RRBM by SSM 2b C +
RRBM by NSM
(NAC sparing) 2b C +
Contralateral prophylactic MX 4 C +/-
Types of Risk Reducing Mastectomy
Oxford / AGO
LoE / GR
* Study participation recommended
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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*Brunnert, K. Gyn. Prax., Band 31, 2007
Algorithm of Breast Reconstruction
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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Algorithm of Autologous
Breast Reconstruction (1)
© AGO e. V. in der DGGG e.V.
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in der DKG e.V.
Guidelines Breast
Version 2015.1
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Algorithm of Autologous
Breast Reconstruction (2)
(MS-2) Double MS-2 pTRAM
or Free TRAM
(MS-2)
Bip TRAM
(MS-2)
fTRAM
DIEP
© AGO e. V. in der DGGG e.V.
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Guidelines Breast
Version 2015.1
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Algorithm of Implant
Breast Reconstruction
Reduction pattern
+ Exp./ Implantat
SSM/NSM
Expander/Implant
Premastectomy Sentinel
Node Biopsy
E/I SSM+E/ I
+Lado
E = expander ; I = implant; CF = Capsula fibrosis; MPS = micropolyurethran surface
Oncoplastic and Reconstructive Surgery (2/21)
Further information and references:
Literature research
Pubmed 2003 – 01/2015
Cochrane data base (z.B. Cochrane Breast Cancer Specialised Register)
Einteilung in EBM-Grade nach Jeremy Howick, Iain Chalmers, Paul Glasziou, Trish Greenhalgh, Carl Heneghan,
Alessandro Liberati, Ivan Moschetti, Bob Phillips, and Hazel Thornton. "The 2011 Oxford CEBM Evidence Levels of
Evidence (Introductory Document)". Oxford Centre for Evidence-Based Medicine.
http://www.cebm.net/index.aspx?o=5653
und Thomssen et al. SOPs für die Überarbeitung der AGO-Leitlinien zum Mammakarzinom 2006 2
Verwendete Guidelines zu Diagnostik und Therapie des Mammakarzinoms:
National Institute of Health (NIH): http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/)
American Association of Clinical Oncology (ASCO) and Technology Assessments:
http://www.asco.org/portal/site/ASCO/menuitem. (Practice Guidelines),
Canadian Medical Association (CMA): http://www.cmaj.ca/cgi/content/full/158/3/DC1
NCCN 2007: http://www.medscape.com/files/editorial/articles/548868/breast.pdf
Definition of oncoplastic surgery (3/21)
Further information:
AGO Voting for giving a new definition 45/0
References:
Definition modified after: Oncoplastic techniques in breast conserving surgery
Benjamin Anderson, MD; Kristine Calhoun, MD http://www.uptodate.com/contents/oncoplastic-techniques-in-breast-
conserving-
surgery?source=machineLearning&search=oncoplastic+surgery&selectedTitle=1%7E1§ionRank=1&anchor=H14027
079#H14027079
Oncoplastic breast conserving surgery (4/21)
Further information:
AGO Voting for this new slide and content 45/0
References:
1. Losken A1, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the
oncoplastic technique. Ann Plast Surg. 2014 Feb;72(2):145-9. doi: 10.1097/SAP.0b013e3182605598.
2. Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, Iera M, Rietjens M, de Lima RS,
Spautz C, Kuroda F, Anselmi K, Capp E. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic
Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol. 2014 Dec 18. [Epub ahead of print]
3. Tan MP, Sitoh NY, Sim AS. Breast conservation treatment for multifocal and multicentric breast cancers in women
with small-volume breast tissue. ANZ J Surg. 2014 Dec 5. doi: 10.1111/ans.12942. [Epub ahead of print]
4. Moustafa A, Fakhr I. Outcome of different oncoplastic surgical (OPs) techniques for centrally located breast cancer
(CLBC). J Egypt Natl Canc Inst. 2014 Dec;26(4):203-9.
5. Park HC, Kim HY, Kim MC, Lee JW, Chung HY, Cho BC, Park HY, Yang JD. Partial breast reconstruction using
various oncoplastic techniques for centrally located breast cancer.
6. Arch Plast Surg. 2014 Sep;41(5):520-8.
7. Losken A, Pinell-White X, Hart AM, Freitas AM, Carlson GW, Styblo TM. The oncoplastic reduction approach to
breast conservation therapy: benefits for margin control. Aesthet Surg J. 2014 Nov;34(8):1185-91.
Algorithm of Breast Reconstruction (5/21)
Further information:
No voting this year
No references
Postmastectomy Reconstruction (6/21)
Further information:
Voting for this new slide and content 45/0
References:
1. Eltahir Y, Werners LL, Dreise MM, Zeijlmans van Emmichoven IA, Werker PM, de Bock GH. Which Breast Is the
Best? Successful Autologous or Alloplastic Breast Reconstruction: Patient-Reported Quality-of-Life Outcomes. Plast
Reconstr Surg. 2015 Jan;135(1):43-50.
2. Fischer JP1, Nelson JA, Au A, Tuggle CT 3rd, Serletti JM, Wu LC. Complications and morbidity following breast
reconstruction--a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg. 2014
Apr;48(2)
3. Wang XL1, Liu LB, Song FM, Wang QY. Meta-analysis of the safety and factors contributing to complications of
MS-TRAM, DIEP, and SIEA flaps forbreast reconstruction. Aesthetic Plast Surg. 2014 Aug;38(4):681-91.
4. Lee KT, Mun GH. Effects of Obesity on Postoperative Complications After Breast Reconstruction Using Free
Muscle-Sparing Transverse Rectus Abdominis Myocutaneous, Deep Inferior Epigastric Perforator, and Superficial
Inferior Epigastric Artery Flap: A Systematic Review and Meta-analysis. Ann Plast Surg. 2014 Dec 19
5. Wang F, Peled AW, Garwood E, Fiscalini AS, Sbitany H, Foster RD, Alvarado M, Ewing C, Hwang ES, Esserman
LJ. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of
outcomes. Ann Surg Oncol. 2014 Oct;21(10):3223-30
6. Fischer JP, Basta MN, Shubinets V, Serletti JM, Fosnot J. A Systematic Meta-analysis of Prosthetic-Based Breast
Reconstruction in Irradiated Fields With or Without Autologous Muscle Flap Coverage. Ann Plast Surg. 2014
7. Santanelli di Pompeo F, Laporta R, Sorotos M, Pagnoni M, Falesiedi F, Longo B. Latissimus dorsi flap for total
autologous immediate breast reconstruction without implants. Plast Reconstr Surg 2014 Dec;134(6):871e-9e
8. Alderman A, Gutowski K, Ahuja A, Gray D; Postmastectomy Expander Implant Breast Reconstruction Guideline
Work Group. ASPS clinical practice guideline summary on breast reconstruction with expanders and implants. Plast
Reconstr Surg. 2014 Oct;134(4):648e-55e
9. Agarwal S, Kidwell KM, Farberg A, Kozlow JH, Chung KC, Momoh AO. Immediate Reconstruction of the
Radiated Breast: Recent Trends Contrary to Traditional Standards. Ann Surg Oncol. 2015 Jan 7
10. Garvey PB, Buchel EW, Pockaj BA, Casey WJ 3rd, Gray RJ, Hernández JL, Samson TD.DIEP and pedicled TRAM
flaps: a comparison of outcomes. Plast Reconstr Surg. 2006 May
11. Man LX, Selber JC, Serletti JM. Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis
and critical review. Plast Reconstr Surg. 2009 Sep; 124(3):752-64.
Timing of Reconstruction (7/21)
Further information:
No voting this year
References:
1. Zhong T, Hofer SO, McCready DR, Jacks LM, Cook FE, Baxter N. A Comparison of Surgical Complications
Between Immediate Breast Reconstruction and Mastectomy: The Impact on Delivery of Chemotherapy-An Analysis
of 391 Procedures. Ann Surg Oncol. 2012 Feb;19(2):
2. Chang RJ, Kirkpatrick K, De Boer RH, Bruce Mann G. Does immediate breast reconstruction compromise the
delivery of adjuvant chemotherapy? Breast. 2013 Feb;22(1):64-9. doi: 10.1016/j.breast.2012.10.008. Epub 2012 Nov
22.
3. D'Souza N, Darmanin G, Fedorowicz Z. Immediate versus delayed reconstruction following surgery for breast
cancer. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008674.
4. Rey P, Martinelli G, Petit JY, Youssef O, De Lorenzi F, Rietjens M, et al. Immediate breast reconstruction and high-
dose chemotherapy. Ann Plast Surg 2005;55:250-4.
5. D'Souza N, Darmanin G, Fedorowicz Z. Immediate versus delayed reconstruction following surgery for breast
cancer. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008674.
6. Albino FP, Koltz PF, Ling MN, Langstein HN. Irradiated autologous breast reconstructions: effects of patient factors
and treatment variables. Plast Reconstr Surg 2010;126:12.
7. Azzawi K, Ismail A, Earl H, Forouhi P, Malata CM. Influence of neoadjuvant chemotherapy on outcomes of
immediate breast reconstruction. Plast Reconstr Surg 2010;126:1.
8. Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast
reconstruction: experience with 1195 flaps. Plast Reconstr Surg 2006;118:1100
9. Schaverien MV, Munnoch DA. Effect of neoadjuvant chemotherapy on outcomes of immediate free autologous
breast reconstruction. Eur J Surg Oncol. 2013 May;39(5):430-6. doi: 10.1016/j.ejso.2013.02.015. Epub 2013 Mar 5.
Timing of Postmastectomy Implant Reconstruction (8/21)
Further information:
AGO voting for implant reconstruction before radiation:
23 voting for +
2 voting for +/-
References:
1. Berbers J, van Baardwijk A, Houben R, Heuts E, Smidt M, Keymeulen K, Bessems M, Tuinder S, Boersma LJ.
Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature. Eur J Cancer.
2014 Nov;50(16):2752-62
2. Kelley BP, Ahmed R, Kidwell KM, Kozlow JH, Chung KC, Momoh AO. A systematic review of morbidity
associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices
ideal? Ann Surg Oncol. 2014 May;21(5):
3. Momoh AO, Ahmed R, Kelley BP, Aliu O, Kidwell KM, Kozlow JH, Chung KC. A systematic review of
complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy.
Ann Surg Oncol. 2014 Jan;21(1):118-24
4. Cordeiro PG, Albornoz CR, McCormick B, Hu Q, Van Zee K. The impact of postmastectomy radiotherapy on two-
stage implant breast reconstruction: an analysis of long-term surgical outcomes, aesthetic results, and satisfaction
over 13 years. Plast Reconstr Surg. 2014 Oct;134(4
5. Aristei C, Falcinelli L, Bini V, Palumbo I, Farneti A, Petitto RP, Gori S, Perrucci E. Expander/implant breast
reconstruction before radiotherapy: outcomes in a single-institute cohort. Strahlenther Onkol. 2012
Dec;188(12):1074-9.
6. Alderman AK et al. Does patient satisfaction with breast reconstruction change over time? Two-year results of the
Michigan Breast Reconstruction Outcomes Study. J Am Coll Surg 2007 Jan;204(1):7-12
7. Cordeiro PG, McCarthy CM. A single surgeon‘s 12-year experience with tissue expander/implant reconstruction:
part I. A prospective analysis of early complications. Part II. An analysis of long-term complications, aesthetic
outcomes, and patients satisfaction. Plast Reconstr Surg 2006 Sep 15; 118(4): 825-839.
8. Kronowitz SJ et al. Delayed-immediate breast reconstruction. Plast Reconstr Surg. 2004;113(6):1617-28.
9. Radiother Oncol. 2008 Oct 31. [
10. Whitfield GA, Horan G, Irwin MS, Malata CM, Wishart GC, Wilson CB. Incidence of severe capsular contracture
following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using
40 Gray in 15 fractions. J Plast Reconstr Aesthet Surg. 2006;59(10):1043-51.
11. Behranwala KA, Dua RS, Ross GM, Ward A, A'hern R, Gui GP. The influence of radiotherapy on capsule formation
and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants.
Plast Reconstr Surg. 2008 Feb;121(2):381-8.
12. Isik FF. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr
Surg. 2008 Jul;122(1):19-28. Links
13. Mirzabeigi MN, Lee M, Smartt JM Jr, Jandali S, Sonnad SS, Serletti JM. Extended trimethoprim/sulfamethoxazole
prophylaxis for implant reconstruction in the previously irradiated chest wall. Plast Reconstr Surg. 2012
Jan;129(1):1e-7e.
14. Bennett SP, Fitoussi AD, Berry MG, Couturaud B, Salmon RJ. Management of exposed, infected implant-based
breast reconstruction and strategies for salvage. J Plast Reconstr Aesthet Surg. 2011 Oct;64(10):1270-7. Epub 2011
Jun 25.
15. Tran T, Tran T, Miles D, Hill M, Lum SS.The impact of radiation on surgical outcomes of immediate breast
reconstruction. Am Surg. 2011 Oct;77(10):1349-52.
16. Brooks S, Djohan R, Tendulkar R, Nutter B, Lyons J, Dietz J. Risk factors for complications of radiation therapy on
tissue expander breast reconstructions. Breast J. 2012 Jan;18(1):28-34. doi: 10.1111/j.1524-4741.2011.01182.x.
Epub 2011 Nov 20.
17. Bennett SP, Fitoussi AD, Berry MG, Couturaud B, Salmon RJ. Management of exposed, infected implant-based
breast reconstruction and strategies for salvage. J Plast Reconstr Aesthet Surg. 2011 Oct;64(10):1270-7. Epub 2011
Jun 25.
Soft tissue replacement techniques (9/21)
Further information:
Voting for new headline 45/0
References:
1. Valdatta L, Cattaneo AG, Pellegatta I, Scamoni S, Minuti A, Cherubino M. Acellular dermal matrices and
radiotherapy in breast reconstruction: a systematic review and meta-analysis of the literature. Plast Surg Int.
2014;2014
2. Phillips BT, Bishawi M, Dagum AB, Bui DT, Khan SU. A systematic review of infection rates and associated
antibiotic duration in acellular dermal matrix breast reconstruction. Eplasty. 2014 Nov 11;14
3. Lynch MP, Chung MT, Rinker BD. A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue
Expander Breast Reconstruction: Long-term Aesthetic Outcomes and Capsular Contracture. Ann Plast Surg. 2014
4. Krishnan NM, Chatterjee A, Rosenkranz KM, Powell SG, Nigriny JF, Vidal DC. The cost effectiveness of acellular
dermal matrix in expander-implant immediate breast reconstruction. J Plast Reconstr Aesthet Surg. 2014
Apr;67(4):468-76
5. Hille-Betz U, Kniebusch N, Wojcinski S, Henseler H, Heyl V, Ohlinger R, Paepke S, Klapdor R, Krause-Bergmann
B. Breast Reconstruction and Revision Surgery for Implant-associated Breast Deformities Using Porcine Acellular
Dermal Matrix: A Multicenter Study of 156 Cases. Ann Surg Oncol. 2014 Oct 10
6. Craig ES, Clemens MW, Koshy J, Wren J, Garvey P, Selber J, Kronowitz S. Outcomes of acellular dermal matrix for
immediate tissue expander reconstruction with radiotherapy. Plast Reconstr Surg. 2014 Oct;134(4 Suppl 1):83-4
7. Basu CB, Jeffers L. The role of acellular dermal matrices in capsular contracture: a review of the evidence. Plast
Reconstr Surg. 2012 Nov;130(5 Suppl 2):118S-24S. doi: 10.1097/PRS.0b013e318262df58.
8. Dieterich M, Reimer T, Dieterich H, Stubert J, Gerber B. A short-term follow-up of implant based breast
reconstruction using a titanium-coated polypropylene mesh (TiLoop(®) Bra). Eur J Surg Oncol. 2012
Dec;38(12):1225-30. doi: 10.1016/j.ejso.2012.08.026. Epub 2012 Sep 13.
9. Elliott LF et al. The scarless latissimus dorsi flap for full muscle coverage in device-based immediate breast
reconstruction: an autologous alternative to acellular dermal matrix. Plast Reconstr Surg. 2011 Jul; 128(1):71-9
10. Gurunluoglu R, Gurunluoglu A, Williams SA, Tebockhorst S. Current trends in breast reconstruction: survey of
American. Society of Plastic Surgeons 2010. Ann Plast Surg 2011
11. Hanna KR, DeGeorge BR Jr, Mericli AF, Lin KY, Drake DB. Comparison study of two types of expander-based
breast reconstruction: acellular dermal matrix-assisted versus total submuscular placement. Ann Plast Surg. 2013
Jan;70(1):10-5. doi: 10.1097/SAP.0b013e31822f6765.
12. Johnson RK, Wright CK, Gandhi A, Charny MC, Barr L. Cost minimisation analysis of using acellular dermal
matrix (Strattice™) for breast reconstruction compared with standard techniques. Eur J Surg Oncol. 2013
Mar;39(3):242-7. doi: 10.1016/j.ejso.2012.12.002. Epub 2012 Dec 21.
13. McCarthy CM, Lee CN, Halvorson EG, Riedel E, Pusic AL, Mehrara BJ, Disa JJ. The use of acellular dermal
matrices in two-stage expander/implant reconstruction: a multicenter, blinded, randomized controlled trial. Plast
Reconstr Surg. 2012 Nov;130(5 Suppl 2):57S-66S. doi: 10.1097/PRS.0b013e31825f05b4.
14. Rulli A, Caracappa D, Castellani E, Arcuri G, Barberini F, Sanguinetti A, Noya G, Pataia E, Covarelli P. Optimizing
therapeutic timing in patients undergoing mastectomy through use of the Tiloop® synthetic mesh: single-step
surgery. In Vivo. 2013 May-Jun;27(3):383-6.
15. Salzberg CA, Dunavant C, Nocera N. Immediate breast reconstruction using porcine acellular dermal matrix
(Strattice™): long-term outcomes and complications. J Plast Reconstr Aesthet Surg. 2013 Mar;66(3):323-8. doi:
10.1016/j.bjps.2012.10.015. Epub 2012 Nov 13.
16. Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with
and without acellular dermal matrix. Plast Reconstr Surg. 2011; 128:403e–410e.
Lipotransfer (10/21)
Further information:
Ago voting for changing the wording from “lipofilling” to “Lipotransfer”: 45/0
Voting for new wording statement 1: 45/0
Reference:
1. Petit JY, Lohsiriwat V, Clough KB, et al. The oncologic outcome and immediate surgical complications of lipofilling
in breast cancer patients: a multicenter study. Milan-Paris-Lyon experience of 646 lipofilling procedures. Plast
Reconstr Surg 2011;128:341–6.
2. Petit JY, Rietjens M, Botteri E, et al. Evaluation of fat grafting safety in patients with intra epithelial neoplasia: A
matched cohort study. Ann Oncol. 2013;24:1479–1484.
3. Rigotti G, Marchi A, Stringhini P, et al. Determining the oncological risk of autologous lipoaspirate grafting for
post-mastectomy breast reconstruction. Ann Plast Surg 2010;34:475–80.
4. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 May.
CADTH Rapid Response Reports. Autologous Fat Grafting for Reconstructive Surgery: A Review of the Clinical
and Cost-Effectiveness [Internet].
5. Khouri RK1, Rigotti G, Cardoso E, Khouri RK Jr, Biggs TM.Megavolume autologous fat transfer: part I. Theory and
principles. Plast Reconstr Surg. 2014 Mar;133(3):550-7.
6. Khouri RK1, Rigotti G, Cardoso E, Khouri RK Jr, Biggs TM Megavolume autologous fat transfer: part II. Practice
and techniques.. Plast Reconstr Surg. 2014 Jun;133(6):1369-77
7. Brenelli F1, Rietjens M, De Lorenzi F, Pinto-Neto A, Rossetto F, Martella S, Rodrigues JR, Barbalho D.Oncological
safety of autologous fat grafting after breast conservative treatment: a prospective evaluation.Breast J. 2014 Mar-
Apr;20(2):159-65
Postmastectomy (pedicled) Reconstruction (11/21)
Further information:
Voting for whole content with one consent
References:
1. Brunnert K, Der TRAM-Lappen – vom Ausnahmeeingriff zur Standardoperation in der Onkoplastik beim
Mammakarzinom. Senologie Lugano, 2000
2. Qadi, Mohamud A. BS; Baltodano, Pablo A. MD; Flores, José M. MPH; Reddy, Sashank MD, PhD; Abt, Nicholas
B. BS; Sarhane, Karim A. MD, MScs; Abreu, Francis M. BS; Azih, Lilian C. MD; Cooney, Carisa M. MPH; Rosson,
Gedge D. MD: Are Flaps Really Better Than Implants for Breast Reconstruction in Obese Females? An Analysis of
89,514 Women Undergoing Breast Surgery from the ACS-NSQIP Database Plastic & Reconstructive Surgery: April
2014 - Volume 133 - Issue 4S - p 982–983
3. Hsieh TY1, Lin YN, Lin SD, Lai CS, Chang KP, Lee SS, Huang SH, Hou MF, Chen FM, Ou-Y Immediate
transverse rectus abdominis musculocutaneous flap reconstruction is associated with improved cancer-specific
survival in locally advanced breast cancer. Ann Plast Surg. 2014 Sep;73 Suppl 1:S31-6.
4. Kelley BP1, Ahmed R, Kidwell KM, Kozlow JH, Chung KC, Momoh AOA systematic review of morbidity
associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices
ideal? Ann Surg Oncol. 2014 May;21(5):1732-8.
5. Garvey PB1, Clemens MW, Hoy AE, Smith B, Zhang H, Kronowitz SJ, Butler CE.Muscle-sparing TRAM flap does
not protect breast reconstruction from postmastectomy radiation damage compared with the DIEP flap. Plast
Reconstr Surg. 2014 Feb;133(2):223-33
6. Berbers J1, van Baardwijk A
2, Houben R
2, Heuts E
3, Smidt M
3, Keymeulen K
3, Bessems M
3, Tuinder S
4, Boersma
LJ5.'Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature. Eur J
Cancer. 2014 Nov;50(16):2752-62.
Free Tissue Transfer (12/21)
Further information:
Voting:
For Free TRAM-flap 11 +; 12 +/-
DIEP-flap + with one consent
References:
1. Garvey PB, Salavati S, Feng L, Butler CE. Perfusion-related complications are similar for DIEP and muscle-sparing
free TRAM flaps harvested on medial or lateral deep inferior epigastric Artery branch perforators for breast
reconstruction. Plast Reconstr Surg. 2011 Dec;128(6):581e-9e.
2. Chang EI1, Chang EI, Soto-Miranda MA, Zhang H, Nosrati N, Crosby MA, Reece GP, Robb GL, Chang DW.
Comprehensive Evaluation of Risk Factors and Management of Impending Flap Loss in 2138 Breast Free Flaps. Ann
Plast Surg. 2014 Jul 4. [Epub ahead of print]
3. Wormald JC1, Wade RG
2, Figus A
3.The increased risk of adverse outcomes in bilateral deep inferior epigastric artery
perforator flap breast reconstruction compared to unilateral reconstruction: a systematic review and meta-analysis. J
Plast Reconstr Aesthet Surg. 2014 Feb;67(2):143-56
4. Schaverien MV1, Mcculley SJ. Effect of obesity on outcomes of free autologous breast reconstruction: a meta-
analysis. Microsurgery. 2014 Sep;34(6):484-97
5. Lee K1, Mun G. Effects of Obesity on Postoperative Complications After Breast Reconstruction Using Free Muscle-
Sparing Transverse Rectus Abdominis Myocutaneous, Deep Inferior Epigastric Perforator, and Superficial Inferior
Epigastric Artery Flap: A Systematic Review and Meta-analysis. Ann Plast Surg. 2014 Dec 19. [Epub ahead of print]
6. Wang XL1, Liu LB, Song FM, Wang QY. Meta-analysis of the safety and factors contributing to complications of
MS-TRAM, DIEP, and SIEA flaps for breast reconstruction. Aesthetic Plast Surg. 2014 Aug;38(4):681-91
Pedicled vs. Free Tissue Transfer (13/21)
Further information:
No voting this year
Reference:
1. Momoh AO, Colakoglu S, Westvik TS, Curtis MS, Yueh JH, de Blacam C, Tobias AM, Lee BT. Analysis of
Complications and Patient Satisfaction in Pedicled Transverse Rectus Abdominis Myocutaneous and Deep Inferior
Epigastric Perforator Flap Breast Reconstruction. Ann Plast Surg. 2011 Jun 8. [Epub ahead of print]
2. Gurunluoglu R1, Bronsert M
1.A comparative analysis of 2 national breast reconstruction surveys: concerns regarding
autologous and microsurgical breast reconstruction. Plast Reconstr Surg Glob Open. 2014 Jun 6;2(5)
Flap-Implant Combination (14/21)
Further information:
No voting this year
References:
1. Kääriäinen M1, Giordano S
2, Kauhanen S
3, Helminen M
4, Kuokkanen H
5. No need to cut the nerve in LD
reconstruction to avoid jumping of the breast: a prospective randomized study. J Plast Reconstr Aesthet Surg. 2014
Aug;67(8):1106-10
2. Fischer JP1, Basta MN, Shubinets V, Serletti JM, Fosnot J A Systematic Meta-analysis of Prosthetic-Based Breast
Reconstruction in Irradiated Fields With or Without Autologous Muscle Flap Coverage. Ann Plast Surg. 2014 Dec
19. [Epub ahead of print]
Skin/Nipple Sparing Mastectomy (SSM/NSM) and Reconstruction (15/21)
Further information:
No voting this year
References:
1. Agrawal A, Sibbering DM, Courtney CA. Skin sparing mastectomy and immediate breast reconstruction: a review.
Eur J Surg Oncol. 2013 Apr;39(4):320-8. doi: 10.1016/j.ejso.2012.12.015. Epub 2013 Jan 17.
2. Gerber B, Krause A, Reimer T, Muller H, Kuchenmeister I, Makovitzky J, Kundt G, Friese K. Skin-sparing
mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe
procedure. Ann Surg. 2003 Jul;238(1):120-7.
3. Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R,
Manconi A, Luini A, Galimberti V, Veronesi P, Ivaldi GB, Orecchia R. Nipple-sparing mastectomy: risk of nipple-
areolar recurrences in a series of 579 cases. Breast Cancer Res Treat. 2008 Mar 22. [Epub ahead of print]
4. Blechman KM, Karp NS, Levovitz C, Guth AA, Axelrod DM, Shapiro RL, Choi M. The lateral inframammary fold
incision for nipple-sparing mastectomy: outcomes from over 50 immediate implant-based breast reconstructions.
Breast J. 2013 Jan-Feb;19(1):31-40. doi: 10.1111/tbj.12043. Epub 2012 Dec 17.
5. Antony AK1, McCarthy C, Disa JJ, Mehrara BJ Bilateral implant breast reconstruction: outcomes, predictors, and
matched cohort analysis in 730 2-stage breast reconstructions over 10 years. Ann Plast Surg. 2014;72(6):625-30
6. Albornoz CR1, Cordeiro PG
1, Pusic AL
1, McCarthy CM
1, Mehrara BJ
1, Disa JJ
1, Matros E
2. Diminishing relative
contraindications for immediate breast reconstruction: a multicenter study. J Am Coll Surg. 2014 Oct;219(4):788-95.
7. Wink JD1, Fischer JP, Nelson JA, Serletti JM, Wu LC. Direct-to-implant breast reconstruction: an analysis of 1612
cases from the ACS-NSQIP surgical outcomes database. J Plast Surg Hand Surg. 2014 Dec;48(6):375-81.
8. Alexandre Mendonça Munhoz, Eduardo Montag, José Roberto Filassi, and Rolf Gemperli Immediate nipple-areola-
sparing mastectomy reconstruction: An update on oncological and reconstruction techniques World J Clin Oncol.
Aug 10, 2014; 5(3): 478–494.
9. Wang F1, Peled AW, Garwood E, Fiscalini AS, Sbitany H, Foster RD, Alvarado M, Ewing C, Hwang ES, Esserman
LJ.Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of
outcomes. Ann Surg Oncol. 2014 Oct;21(10):3223-30.
Bilateral Risk Reducing Mastectomy in healthy women (RRBM) (16/21)
Further information:
No voting this year
Please see chapter breast Cancer Risk and Prevention
References:
1. Heemskerk-Gerritsen BA, Brekelmans CT, Menke-Pluymers MB, van Geel AN, Tilanus-Linthorst MM, Bartels CC,
Tan M, Meijers-Heijboer HE, Klijn JG, Seynaeve C. Prophylactic mastectomy in BRCA1/2 mutation carriers and
women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic. Ann Surg
Oncol. 2007 Dec;14(12):3335-44. Epub 2007 May 31. Links
2. Den Heijer M, van Asperen CJ, Harris H, Nippert I, Schmidtke J, Bouhnik AD, Julian-Reynier C, Evans DG, Tibben
A. International variation in physicians' attitudes towards prophylactic mastectomy - comparison between France,
Germany, the Netherlands and the United Kingdom. Eur J Cancer. 2013 Sep;49(13):2798-805. doi:
10.1016/j.ejca.2013.04.025. Epub 2013 May 18.
Types of Risk Reducing Mastectomy (17/21)
Further information:
No voting this year
Please see chapter breast Cancer Risk and Prevention
References:
1. Sahin I, Isik S, Alhan D, Yıldız R, Aykan A, Ozturk E. One-staged silicone implant breast reconstruction following
bilateral nipple-sparing prophylactic mastectomy in patients at high-risk for breast cancer. Aesthetic Plast Surg. 2013
Apr;37(2):303-11. doi: 10.1007/s00266-012-0044-6. Epub 2013 Jan 16.
2. Soran A, Ibrahim A, Kanbour M, McGuire K, Balci FL, Polat AK, Thomas C, Bonaventura M, Ahrendt G, Johnson
R. Decision Making and Factors Influencing Long-term Satisfaction With Prophylactic Mastectomy in Women With
Breast Cancer. Am J Clin Oncol. 2013 May 2. [Epub ahead of print]
3. Jessica Gahm, Per Hansson, Yvonne Brandberg, Marie Wickman; Breast sensibility after bilateral riskreducing
mastectomy and immediate breast reconstruction: A prospective study; Journal of Plastic, Reconstructive &
Aesthetic Surgery (2013) 66, 1521e1527
4. Jonas A. Nelson, John P. Fischer , M. Anne Radecki , Christina Pasick , Jennifer McGrath , Joseph M. Serletti , Liza
C. Wu; Delayed autologous breast reconstruction: Factors which influence patient decision making. Journal of
Plastic, Reconstructive & Aesthetic Surgery (2013) 66, 1513e1520
Algorithm of Breast Reconstruction (18/21) and
Algorithm of Autologous Breast Reconstruction (1) (19/21) and
Algorithm of Autologous Breast Reconstruction (2) (20/21) and
Algorithm of Implant Breast Reconstruction (4) (21/21)
Further information:
No voting this year
No references