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.
Similar content being viewed by others
References
Benelli L (1990) A new periareolar mammaplasty: the “round block” technique. Aesthet Plast Surg 14:93–100
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 96:363–370
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:1093–1096
Silverstein MJ, Mai T, Savalia N, Vaince F, Guerra L (2014) Oncoplastic breast conservation surgery: the new paradigm. J Surg Oncol 110:82–89
Anderson BO, Masetti R, Silverstein MJ (2005) Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 6:145–157
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 17:1375–1391
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 9:108
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 21:133–141
Piper M, Peled AW, Sbitany H (2015) Oncoplastic breast surgery: current strategies. Gland Surg 4:154–163
Rainsbury RM (2007) Surgery insight: oncoplastic breast-conserving reconstruction–indications, benefits, choices and outcomes. Nat Clin Pract Oncol 4:657–664
Rezai M, Kraemer S, Kimmig R, Kern P (2015) Breast conservative surgery and local recurrence. Breast 24(Suppl 2):S100–S107
Urban C, Lima R, Schunemann E, Spautz C, Rabinovich I, Anselmi K (2011) Oncoplastic principles in breast conserving surgery. Breast 20(Suppl 3):S92–S95
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
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 257:609–620
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 12:334–339
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
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):3247–3258
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 17:1158–1170
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 21:704–716
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 22:2500–2508
Losken A, Dugal CS, Styblo TM, Carlson GW (2014) A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 72:145–149
Down SK, Jha PK, Burger A, Hussien MI (2013) Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J 19:56–63
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 255:1151–1157
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 22:4247–4253
Bertolini F, Petit JY, Kolonin MG (2015) Stem cells from adipose tissue and breast cancer: hype, risks and hope. Br J Cancer 112:419–423
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 42:1088–1102
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 41:612–616
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 23:776–781
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 124:345–353
Cardoso JS, Cardoso MJ (2007) Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med 40:115–126
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 16:429–435
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 13:140–146
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 247:470–476
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–S23
Funding
No commercial funding was received for this conference.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Jörg Heil, Markus Hahn, Jens-Uwe Blohmer, Jürgen Hoffmann, Christine Solbach, Christoph Heitmann, Bernd Gerber—Official delegates of the German Society of Senology.
Florian Fitzal, Vesna Bjelic-Radisic, Roland Reitsamer, Rupert Koller—Official delegates of the Austrian Society of Senology.
Walter P. Weber, Savas D. Soysal, Michael Knauer, Christoph Tausch, Nik Hauser, Andreas Günthert, Yves Harder—Official delegates of the Swiss Society of Senology.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Weber, W.P., Soysal, S.D., El-Tamer, M. et al. First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 165, 139–149 (2017). https://doi.org/10.1007/s10549-017-4314-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-017-4314-5