Advertisement

Breast Cancer Research and Treatment

, Volume 165, Issue 1, pp 139–149 | Cite as

First international consensus conference on standardization of oncoplastic breast conserving surgery

  • Walter P. WeberEmail author
  • Savas D. Soysal
  • Mahmoud El-Tamer
  • Virgilio Sacchini
  • Michael Knauer
  • Christoph Tausch
  • Nik Hauser
  • Andreas Günthert
  • Yves Harder
  • Elisabeth A. Kappos
  • Fabienne Schwab
  • Florian Fitzal
  • Peter Dubsky
  • Vesna Bjelic-Radisic
  • Roland Reitsamer
  • Rupert Koller
  • Jörg Heil
  • Markus Hahn
  • Jens-Uwe Blohmer
  • Jürgen Hoffmann
  • Christine Solbach
  • Christoph Heitmann
  • Bernd Gerber
  • Martin Haug
  • Christian Kurzeder
Clinical trial

Abstract

Purpose

To obtain consensus recommendations for the standardization of oncoplastic breast conserving surgery (OPS) from an international panel of experts in breast surgery including delegates from the German, Austrian and Swiss societies of senology.

Methods

A total of 52 questions were addressed by electronic voting. The panel’s recommendations were put into context with current evidence and the report was circled in an iterative open email process until consensus was obtained.

Results

The panelists considered OPS safe and effective for improving aesthetic outcomes and broadening the indication for breast conserving surgery (BCS) towards larger tumors. A slim majority believed that OPS reduces the rate of positive margins; however, there was consensus that OPS is associated with an increased risk of complications compared to conventional BCS. The panel strongly endorsed patient-reported outcomes measurement, and recommended selected scales of the Breast-Q™-Breast Conserving Therapy Module for that purpose. The Clough bi-level classification was recommended for standard use in clinical practice for indicating, planning and performing OPS, and the Hoffmann classification for surgical reports and billing purposes. Mastopexy and reduction mammoplasty were the only two recognized OPS procedure categories supported by a majority of the panel. Finally, the experts unanimously supported the statement that every OPS procedure should be tailored to each individual patient.

Conclusions

When implemented into clinical practice, the panel recommendations may improve safety and effectiveness of OPS. The attendees agreed that there is a need for prospective multicenter studies to optimize patient selection and for standardized criteria to qualify and accredit OPS training centers.

Keywords

Oncoplastic surgery Breast conserving surgery Breast surgery Breast cancer 

Notes

Funding

No commercial funding was received for this conference.

Compliance with ethical standards

Conflict of interest

Author Florian Fitzal invented the Breast Analyzing Tool (BAT) for symmetry measurements in breast surgery. Walter P. Weber, Savas D. Soysal, Mahmoud El-Tamer, Virgilio Sacchini, Michael Knauer, Christoph Tausch, Nik Hauser, Andreas Günthert, Yves Harder, Elisabeth A Kappos, Fabienne Schwab, Peter Dubsky, Vesna Bjelic-Radisic, Roland Reitsamer, Rupert Koller, Jörg Heil, Markus Hahn, Jens-Uwe Blohmer, Jürgen Hoffmann, Christine Solbach, Christoph Heitmann, Bernd Gerber, Martin Haug, Christian Kurzeder declare that they have no conflict of interest in the context of this publication.

Supplementary material

10549_2017_4314_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)
10549_2017_4314_MOESM2_ESM.docx (45 kb)
Supplementary material 2 (DOCX 45 kb)

References

  1. 1.
    Benelli L (1990) A new periareolar mammaplasty: the “round block” technique. Aesthet Plast Surg 14:93–100CrossRefGoogle Scholar
  2. 2.
    Clough KB, Nos C, Salmon RJ, Soussaline M, Durand JC (1995) Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg 96:363–370CrossRefPubMedGoogle Scholar
  3. 3.
    Galimberti V, Zurrida S, Zanini V, Callegari M, Veronesi P, Catania S, Luini A, Greco M, Grisotti A (1993) Central small size breast cancer: how to overcome the problem of nipple and areola involvement. Eur J Cancer 29A:1093–1096CrossRefPubMedGoogle Scholar
  4. 4.
    Silverstein MJ, Mai T, Savalia N, Vaince F, Guerra L (2014) Oncoplastic breast conservation surgery: the new paradigm. J Surg Oncol 110:82–89CrossRefPubMedGoogle Scholar
  5. 5.
    Anderson BO, Masetti R, Silverstein MJ (2005) Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 6:145–157CrossRefPubMedGoogle Scholar
  6. 6.
    Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM (2010) Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 17:1375–1391CrossRefPubMedGoogle Scholar
  7. 7.
    Hoffmann J, Wallwiener D (2009) Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer 9:108CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Iwuchukwu OC, Harvey JR, Dordea M, Critchley AC, Drew PJ (2012) The role of oncoplastic therapeutic mammoplasty in breast cancer surgery–a review. Surg Oncol 21:133–141CrossRefPubMedGoogle Scholar
  9. 9.
    Piper M, Peled AW, Sbitany H (2015) Oncoplastic breast surgery: current strategies. Gland Surg 4:154–163PubMedPubMedCentralGoogle Scholar
  10. 10.
    Rainsbury RM (2007) Surgery insight: oncoplastic breast-conserving reconstruction–indications, benefits, choices and outcomes. Nat Clin Pract Oncol 4:657–664CrossRefPubMedGoogle Scholar
  11. 11.
    Rezai M, Kraemer S, Kimmig R, Kern P (2015) Breast conservative surgery and local recurrence. Breast 24(Suppl 2):S100–S107CrossRefPubMedGoogle Scholar
  12. 12.
    Urban C, Lima R, Schunemann E, Spautz C, Rabinovich I, Anselmi K (2011) Oncoplastic principles in breast conserving surgery. Breast 20(Suppl 3):S92–S95CrossRefPubMedGoogle Scholar
  13. 13.
    Weber WP, Soysal SD, Fulco I, Barandun M, Babst D, Kalbermatten D, Schaefer DJ, Oertli D, Kappos EA, Haug M (2017) Standardization of oncoplastic breast conserving surgery. Eur J Surg Oncol. doi: 10.1016/j.ejso.2017.01.006 Google Scholar
  14. 14.
    Haloua MH, Krekel NM, Winters HA, Rietveld DH, Meijer S, Bloemers FW, van den Tol MP (2013) A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg 257:609–620CrossRefPubMedGoogle Scholar
  15. 15.
    Panhofer P, Ferenc V, Schutz M, Gleiss A, Dubsky P, Jakesz R, Gnant M, Fitzal F (2014) Standardization of morbidity assessment in breast cancer surgery using the Clavien Dindo classification. Int J Surg 12:334–339CrossRefPubMedGoogle Scholar
  16. 16.
    Carter SA, Lyons GR, Kuerer HM, Bassett RL Jr, Oates S, Thompson A, Caudle AS, Mittendorf EA, Bedrosian I, Lucci A, DeSnyder SM, Babiera G, Yi M, Baumann DP, Clemens MW, Garvey PB, Hunt KK, Hwang RF (2016) Operative and oncologic outcomes in 9861 patients with operable breast cancer: single-institution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol. doi: 10.1245/s10434-016-5407-9 PubMedCentralGoogle Scholar
  17. 17.
    De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher CS (2016) Outcomes After oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol 23(10):3247–3258CrossRefGoogle Scholar
  18. 18.
    van Maaren MC (2016) de ML, de Bock GH, Jobsen JJ, van DT, Linn SC, Poortmans P, Strobbe LJ, Siesling S: 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol 17:1158–1170CrossRefPubMedGoogle Scholar
  19. 19.
    Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M (2014) Society of surgical oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol 21:704–716CrossRefPubMedGoogle Scholar
  20. 20.
    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 (2015) Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol 22:2500–2508CrossRefPubMedGoogle Scholar
  21. 21.
    Losken A, Dugal CS, Styblo TM, Carlson GW (2014) A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 72:145–149CrossRefPubMedGoogle Scholar
  22. 22.
    Down SK, Jha PK, Burger A, Hussien MI (2013) Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J 19:56–63CrossRefPubMedGoogle Scholar
  23. 23.
    Chang EI, Peled AW, Foster RD, Lin C, Zeidler KR, Ewing CA, Alvarado M, Hwang ES, Esserman LJ (2012) Evaluating the feasibility of extended partial mastectomy and immediate reduction mammoplasty reconstruction as an alternative to mastectomy. Ann Surg 255:1151–1157CrossRefPubMedGoogle Scholar
  24. 24.
    Clough KB, Gouveia PF, Benyahi D, Massey EJ, Russ E, Sarfati I, Nos C (2015) Positive margins after oncoplastic surgery for breast cancer. Ann Surg Oncol 22:4247–4253CrossRefPubMedGoogle Scholar
  25. 25.
    Bertolini F, Petit JY, Kolonin MG (2015) Stem cells from adipose tissue and breast cancer: hype, risks and hope. Br J Cancer 112:419–423CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Gennari R, Griguolo G, Dieci MV, Guarneri V, Tavaniello B, Sibilio A, Conte P (2016) Fat grafting for breast cancer patients: from basic science to clinical studies. Eur J Surg Oncol 42:1088–1102CrossRefPubMedGoogle Scholar
  27. 27.
    Masia J, Bordoni D, Pons G, Liuzza C, Castagnetti F, Falco G (2015) Oncological safety of breast cancer patients undergoing free-flap reconstruction and lipofilling. Eur J Surg Oncol 41:612–616CrossRefPubMedGoogle Scholar
  28. 28.
    Mestak O, Hromadkova V, Fajfrova M, Molitor M, Mestak J (2016) Evaluation of oncological safety of fat grafting after breast-conserving therapy: a prospective study. Ann Surg Oncol 23:776–781CrossRefPubMedGoogle Scholar
  29. 29.
    Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ (2009) Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 124:345–353CrossRefPubMedGoogle Scholar
  30. 30.
    Cardoso JS, Cardoso MJ (2007) Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med 40:115–126CrossRefPubMedGoogle Scholar
  31. 31.
    Fitzal F, Krois W, Trischler H, Wutzel L, Riedl O, Kuhbelbock U, Wintersteiner B, Cardoso MJ, Dubsky P, Gnant M, Jakesz R, Wild T (2007) The use of a breast symmetry index for objective evaluation of breast cosmesis. Breast 16:429–435CrossRefPubMedGoogle Scholar
  32. 32.
    Cardoso MJ, Cardoso J, Santos AC, Vrieling C, Christie D, Liljegren G, Azevedo I, Johansen J, Rosa J, Amaral N, Saaristo R, Sacchini V, Barros H, Oliveira MC (2007) Factors determining esthetic outcome after breast cancer conservative treatment. Breast J 13:140–146CrossRefPubMedGoogle Scholar
  33. 33.
    Fitzal F, Mittlboeck M, Trischler H, Krois W, Nehrer G, Deutinger M, Jakesz R, Gnant M (2008) Breast-conserving therapy for centrally located breast cancer. Ann Surg 247:470–476CrossRefPubMedGoogle Scholar
  34. 34.
    Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F, Gooch H, Harcourt D, Martin L, Rainsbury D, Rayter Z, Sheppard C, Smith J, Weiler-Mithoff E, Winstanley J, Church J (2007) Oncoplastic breast surgery–a guide to good practice. Eur J Surg Oncol 33(Suppl 1):S1–S23PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Walter P. Weber
    • 1
    Email author
  • Savas D. Soysal
    • 1
  • Mahmoud El-Tamer
    • 3
  • Virgilio Sacchini
    • 3
  • Michael Knauer
    • 2
  • Christoph Tausch
    • 7
  • Nik Hauser
    • 8
  • Andreas Günthert
    • 9
  • Yves Harder
    • 10
  • Elisabeth A. Kappos
    • 1
  • Fabienne Schwab
    • 1
  • Florian Fitzal
    • 6
  • Peter Dubsky
    • 5
    • 6
  • Vesna Bjelic-Radisic
    • 16
  • Roland Reitsamer
    • 18
  • Rupert Koller
    • 19
  • Jörg Heil
    • 11
  • Markus Hahn
    • 13
  • Jens-Uwe Blohmer
    • 4
  • Jürgen Hoffmann
    • 15
  • Christine Solbach
    • 12
  • Christoph Heitmann
    • 17
  • Bernd Gerber
    • 14
  • Martin Haug
    • 1
  • Christian Kurzeder
    • 1
  1. 1.Breast CenterUniversity Hospital BaselBaselSwitzerland
  2. 2.Breast Center St. GallenSt. GallenSwitzerland
  3. 3.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Gynecology with Breast CenterCharité Universitätsmedizin BerlinBerlinGermany
  5. 5.Breast CenterHirslanden Klinik St. AnnaLucerneSwitzerland
  6. 6.Department of Surgery and Comprehensive Cancer Center ViennaMedical University ViennaViennaAustria
  7. 7.Breast-Center ZurichZurichSwitzerland
  8. 8.Breast Center Hirslanden Clinics Aarau Cham Zug and frauenarztzentrum aargau agBadenSwitzerland
  9. 9.Department of Obstetrics and GynecologyCantonal Hospital of LucerneLucerneSwitzerland
  10. 10.Division of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano (ORL), Breast Centre of Switzerland (CSSI)Ente Ospedaliero Cantonale (EOC)LuganoSwitzerland
  11. 11.Universitäts-BrustzentrumUniversitäts-FrauenklinikHeidelbergGermany
  12. 12.Breast CenterUniversity Hospital FrankfurtFrankfurtGermany
  13. 13.Department of Women’s HealthUniversity Breast Center TubingenTübingenGermany
  14. 14.Breast Surgery Unit at the Department of Ob/GynUniversity Hospital RostockRostockGermany
  15. 15.Breast CenterUniversity Hospital DüsseldorfDüsseldorfGermany
  16. 16.Department of GynecologyMedical Univerisity GrazGrazAustria
  17. 17.Breast Center at the English GardenMunichGermany
  18. 18.Breast Center Salzburg, University Clinic SalzburgParacelsus Medical University SalzburgSalzburgAustria
  19. 19.Plastische, Ästhetische und Rekonstruktive ChirurgieViennaAustria

Personalised recommendations