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International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy
M B Nava1, J R Benson2,3, W Audretsch4
1Department of Plastic Surgery, University of Milan, Milan, Italy.
The British Journal of Surgery
|July 19, 2019
Summary
Conflicting evidence on breast reconstruction after radiotherapy complicates treatment decisions. More high-quality research is needed to guide optimal patient care and informed consent regarding oncoplastic breast surgery.
Area of Science:
- Oncoplastic Breast Surgery
- Radiation Oncology
- Plastic Surgery
Background:
- Conflicting evidence complicates clinical decision-making for breast reconstruction in patients undergoing radiotherapy.
- Current literature on radiotherapy and breast reconstruction (1985-2017) was reviewed to identify key issues.
Framework:
- A systematic literature review identified 1522 publications, leading to 30 controversial questions.
- Nineteen experts convened to discuss and reach consensus on 22 key statements derived from the literature.
Implementation:
- The highest levels of evidence (LoE) for each statement ranged from II to IV, with most (50%) supported by LoE III.
- Full consensus was achieved for 41% of statements, with over 75% agreement for 50%.
Implications:
- Limited high-quality evidence hinders informed consent and consensus on optimal breast reconstruction techniques and timing post-radiotherapy.
- There is a critical need for prospective registries and randomized trials to generate robust evidence in this field.
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