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.