Breast Units And Nipple-Sparing Mastectomy: A National Portrait Compared To International Consensus (Part 1)
Abstract
Introducion: The Chapter of Breast Surgery of the Portuguese Society of Surgery aimed to find out how hospitals treating breast cancer (BC) in Portugal are organized into breast units and how nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is performed in clinical practice.
Methods: Forty-five hospitals were invited to participate in an anonymous online survey in March 2023, just before the XLIII National Congress of Surgery. A qualitative and quantitative description of the responses was made. A complementary comparison was made with two international consensus, one from the European Society of Breast Cancer Specialists (EUSOMA) and the other from the Oncoplastic Breast Consortium (OPBC).
Results: We received 31 responses (68.9%). Almost all hospitals (96.8%) had an organized breast unit. The national units meet the main EUSOMA requirements: multidisciplinary organization (100%), inclusion of at least two fully dedicated breast surgeons (100%), and a minimum volume of 150 newly diagnosed BC per year (77.4%). The OPBC expert consensus that NSM should only be performed by high-volume surgeons can be inferred in our national units based on 3 criteria: the annual volume of newly diagnosed BC, the number of dedicated surgeons, and the volume of NSM performed per year. All national units routinely perform NSM, but only 10% reported a high volume of more than 50 NSM per year. In cautious agreement with the OPBC statement on the oncological safety of NSM, half of the 30 breast units questioned it given the lack of long-term outcomes. Inflammatory carcinoma and direct nipple involvement were considered the only absolute contraindications to NSM. Other possible NSM contraindications were considered relative or questionable.
Conclusion: This national portrait has demonstrated that well-organized, efficient breast units with an adequate volume of care are already in place in most hospitals treating BC. Similarly, the technical (and temporal) differentiation of breast surgeons has been demonstrated by the successful completion of a differentiated surgical procedure such as NSM plus IBR in daily practice.
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References
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2. Weber WP, Haug M, Kurzeder C, Bjelic-Radisic V, Koller R, Reitsamer R, Fitzal F, Biazus J, Brenelli F, Urban C, Paulinelli RR, Blohmer JU, Heil J, Hoffmann J, Matrai Z, Catanuto G, Galimberti V, Gentilini O, Barry M, Hadar T, Allweis TM, Olsha O, Cardoso MJ, Gouveia PF, Rubio IT, de Boniface J, Svensjö T, Bucher S, Dubsky P, Farhadi J, Fehr MK, Fulco I, Ganz-Blättler U, Günthert A, Harder Y, Hauser N, Kappos EA, Knauer M, Landin J, Mechera R, Meani F, Montagna G, Ritter M, Saccilotto R, Schwab FD, Steffens D, Tausch C, Zeindler J, Soysal SD, Lohsiriwat V, Kovacs T, Tansley A, Wyld L, Romics L, El-Tamer M, Pusic AL, Sacchini V, Gnant M. Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat. 2018 Dec;172(3):523-537. doi: 10.1007/s10549-018-4937-1. Epub 2018 Sep 4. PMID: 30182349; PMCID: PMC6245050.
3. Veronesi U, Stafyla V, Luini A, Veronesi P. Breast cancer: from “maximum tolerable” to “minimum effective” treatment. Front Oncol. 2012 Oct 8;2:125. doi: 10.3389/fonc.2012.00125. PMID: 23061042; PMCID: PMC3465814.
4. Spear SL, Hannan CM, Willey SC, Cocilovo C. Nipple-sparing mastectomy. Plast Reconstr Surg. 2009 Jun;123(6):1665-1673. doi: 10.1097/PRS.0b013e3181a64d94. PMID: 19483564.
5. Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, Veronesi P. Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. Breast. 2017 Aug;34 Suppl 1(Suppl 1):S82-S84. doi: 10.1016/j.breast.2017.06.034. Epub 2017 Jun 30. PMID: 28673535; PMCID: PMC5837802.
6. Toesca A, Peradze N, Manconi A, Galimberti V, Intra M, Colleoni M, Bonanni B, Curigliano G, Rietjens M, Viale G, Sacchini V, Veronesi P. Robotic nipple-sparing mastectomy for the treatment of breast cancer: Feasibility and safety study. Breast. 2017 Feb;31:51-56. doi: 10.1016/j.breast.2016.10.009. Epub 2016 Nov 2. PMID: 27810700; PMCID: PMC5278881.
7. Toesca A, Peradze N, Galimberti V, Manconi A, Intra M, Gentilini O, Sances D, Negri D, Veronesi G, Rietjens M, Zurrida S, Luini A, Veronesi U, Veronesi P. Robotic Nipple-sparing Mastectomy and Immediate Breast Reconstruction With Implant: First Report of Surgical Technique. Ann Surg. 2017 Aug;266(2):e28-e30. doi: 10.1097/SLA.0000000000001397. PMID: 28692558.
8. Sarfati B, Struk S, Leymarie N, Honart JF, Alkhashnam H, Tran de Fremicourt K, Conversano A, Rimareix F, Simon M, Michiels S, Kolb F. Robotic Prophylactic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: A Prospective Study. Ann Surg Oncol. 2018 Sep;25(9):2579-2586. doi: 10.1245/s10434-018-6555-x. Epub 2018 Jun 29. PMID: 29959612.
9. Angarita FA, Castelo M, Englesakis M, McCready DR, Cil TD. Robot-assisted nipple-sparing mastectomy: systematic review. Br J Surg. 2020 Nov;107(12):1580-1594. doi: 10.1002/bjs.11837. Epub 2020 Aug 26. PMID: 32846014.
10. Morrow M. Robotic mastectomy: the next major advance in breast cancer surgery? Br J Surg. 2021 Apr 5;108(3):233-234. doi: 10.1093/bjs/znab010. PMID: 33723570; PMCID: PMC10576415.
11. Park HS, Lee J, Lai HW, Park JM, Ryu JM, Lee JE, Kim JY, Marrazzo E, De Scalzi AM, Corso G, Montemurro F, Gazzetta G, Pozzi G, Toesca A. Surgical and Oncologic Outcomes of Robotic and Conventional Nipple-Sparing Mastectomy with Immediate Reconstruction: International Multicenter Pooled Data Analysis. Ann Surg Oncol. 2022 Oct;29(11):6646-6657. doi: 10.1245/s10434-022-11865-x. Epub 2022 May 18. PMID: 35583693.
12. Morrow M. Robotic Nipple-Sparing Mastectomy-Ready for Prime Time? JAMA Surg. 2024 Mar 1;159(3):276. doi: 10.1001/jamasurg.2023.7007. PMID: 38231509.
13. Esgueva AJ, Noordhoek I, Kranenbarg EM, Espinosa-Bravo M, Mátrai Z, Zhygulin A, Irmejs A, Mavioso C, Meani F, González E, Özdemir M, Allweis T, Rogowski K, Dos Santos CR, Mora H, Ponzone R, Samorani D, van de Velde C, Audisio RA, Rubio IT; INSPIRE collaborators group. Health-Related Quality of Life After Nipple-Sparing Mastectomy: Results From the INSPIRE Registry. Ann Surg Oncol. 2022 Mar;29(3):1722-1734. doi: 10.1245/s10434-021-10930-1. Epub 2021 Nov 8. Erratum in: Ann Surg Oncol. 2022 Sep;29(9):5828. PMID: 34748122.
Published
2024-07-29
How to Cite
OSÓRIO, Fernando et al.
Breast Units And Nipple-Sparing Mastectomy: A National Portrait Compared To International Consensus (Part 1).
Revista Portuguesa de Cirurgia, [S.l.], n. 57, p. 67-78, july 2024.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/1034>. Date accessed: 19 aug. 2024.
doi: https://doi.org/10.34635/rpc.1034.
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Section
Original Papers