title: Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline.
abstract: The side effects of mastectomy can be significant. Breast reconstruction may alleviate some distress; however, there are currently no provincial recommendations regarding the integration of reconstruction with breast cancer therapy. The purpose of the present article is to provide evidence-based strategies for the management of patients who are candidates for reconstruction. A systematic review of meta-analyses, guidelines, clinical trials and comparative studies published between 1980 and 2013 was conducted using the PubMed and EMBASE databases. Reference lists of publications were manually searched for additional literature. The National Guidelines Clearinghouse and SAGE directory, as well as guideline developers' websites, were also searched. Recommendations were developed based on the available evidence. Reconstruction consultation should be made available for patients undergoing mastectomy. Tumour characteristics, cancer therapy, patient comorbidities, body habitus and smoking history may affect reconstruction outcomes. Although immediate reconstruction should be considered whenever possible, delayed reconstruction is acceptable when immediate is not available or appropriate. The integration of reconstruction and postmastectomy radiotherapy should be addressed in a multidisciplinary setting. The decision as to which type of procedure to perform (autologous or alloplastic with or without acellular dermal matrices) should be left to the discretion of the surgeons and the patient after providing counselling. Skin-sparing mastectomy is safe and appropriate. Nipple-sparing is generally not recommended for patients with malignancy, but could be considered for carefully selected patients. Immediate reconstruction requires resources to coordinate operating room time between the general and plastic surgeons, to provide supplies including acellular dermal matrices, and to develop the infrastructure needed to facilitate multidisciplinary discussions.
authors.affiliation: CancerControl Alberta, Alberta Health Services;
authors.forename: Melissa
authors.initials: M
authors.lastname: Shea-Budgell
authors.affiliation: Division of Surgical Oncology, University of Calgary, Calgary;
authors.forename: May Lynn
authors.initials: ML
authors.lastname: Quan
authors.affiliation: Division of Plastic Surgery, University of Alberta, Edmonton;
authors.forename: Blair
authors.initials: B
authors.lastname: Mehling
authors.affiliation: Divisions of Plastic Surgery and Surgical Oncology, Calgary, Alberta.
authors.forename: Claire
authors.initials: C
authors.lastname: Temple-Oberle
keywords: Breast cancer; Breast reconstruction; Guideline; Mastectomy
references.citation: Plast Reconstr Surg. 2006 Jun;117(7):2182-90
references.pmid: 16772915
references.citation: Ann Oncol. 2011 Mar;22(3):515-523
references.pmid: 20603440
references.citation: Br J Surg. 1995 Jan;82(1):79-82
references.pmid: 7881965
references.citation: Cancer. 2001 Apr 1;91(7):1238-46
references.pmid: 11283922
references.citation: Plast Reconstr Surg. 2011 Aug;128(2):353-359
references.pmid: 21788827
references.citation: Ann Plast Surg. 1994 Jan;32(1):32-8
references.pmid: 8141534
references.citation: Plast Reconstr Surg. 2005 Apr 15;115(5):1289-96
references.pmid: 15809588
references.citation: Br J Surg. 2013 Jan;100(2):240-51
references.pmid: 23175286
references.citation: Eplasty. 2011;11:e40
references.pmid: 22084645
references.citation: Acta Chir Belg. 2003 Feb;103(1):98-101
references.pmid: 12658886
references.citation: Ann Surg. 2010 Apr;251(4):632-9
references.pmid: 20224371
references.citation: Am J Psychiatry. 1985 Jan;142(1):40-6
references.pmid: 3966585
references.citation: Breast Cancer Res Treat. 2008 Dec;112(3):545-9
references.pmid: 18210199
references.citation: Ann R Coll Surg Engl. 2011 Mar;93(2):106-10
references.pmid: 21054923
references.citation: Ann Oncol. 2010 May;21 Suppl 5:v9-14
references.pmid: 20555111
references.citation: Arch Surg. 2010 Sep;145(9):873-8
references.pmid: 20855758
references.citation: Ann Surg Oncol. 2012 Jan;19(1):233-41
references.pmid: 21674270
references.citation: Plast Reconstr Surg. 2007 Oct;120(5):1125-1132
references.pmid: 17898585
references.citation: Arch Pediatr Adolesc Med. 2002 Jan;156(1):11-3
references.pmid: 11772184
references.citation: Int J Radiat Oncol Biol Phys. 1985 Jun;11(6):1117-9
references.pmid: 3997593
references.citation: Breast. 2012 Jun;21(3):230-6
references.pmid: 22225710
references.citation: Plast Reconstr Surg. 2004 Mar;113(3):877-81
references.pmid: 15108879
references.citation: Breast Cancer Res Treat. 2010 Jun;121(3):627-34
references.pmid: 20424909
references.citation: Breast. 2007 Dec;16(6):547-67
references.pmid: 18024116
references.citation: Plast Reconstr Surg. 2009 Dec;124(6):1735-1740
references.pmid: 19952627
references.citation: Ann Plast Surg. 2011 May;66(5):518-22
references.pmid: 21451387
references.citation: Health Psychol. 2011 Nov;30(6):683-92
references.pmid: 21728421
references.citation: Plast Reconstr Surg. 1992 Sep;90(3):455-62
references.pmid: 1387483
references.citation: Plast Reconstr Surg. 2012 Nov;130(5 Suppl 2):104S-115S
references.pmid: 23096958
references.citation: Breast Cancer Res Treat. 2010 Jul;122(2):439-51
references.pmid: 20502959
references.citation: Eur J Cancer. 2000 Oct;36(15):1938-43
references.pmid: 11000574
references.citation: Int J Surg. 2012;10(5):259-64
references.pmid: 22525383
references.citation: Am J Surg. 2008 Oct;196(4):519-22
references.pmid: 18809054
references.citation: Plast Reconstr Surg. 2006 Mar;117(3):757-67; discussion 768-72
references.pmid: 16525261
references.citation: Plast Reconstr Surg. 2013 Jan;131(1):9e-18e
references.pmid: 22990174
references.citation: J Am Coll Surg. 2007 Jan;204(1):7-12
references.pmid: 17189107
references.citation: Br J Plast Surg. 1999 Mar;52(2):104-11
references.pmid: 10434888
references.citation: Breast Cancer Res Treat. 2011 May;127(1):15-22
references.pmid: 21336948
references.citation: Plast Reconstr Surg. 1997 Oct;100(5):1153-60
references.pmid: 9326776
references.citation: Ann Surg. 2008 Jun;247(6):1019-28
references.pmid: 18520230
references.citation: Eur J Surg Oncol. 2010 Aug;36(8):745-9
references.pmid: 20605080
references.citation: Aesthetic Plast Surg. 2011 Feb;35(1):66-72
references.pmid: 20676887
references.citation: Ann Plast Surg. 2012 Apr;68(4):346-56
references.pmid: 22421476
references.citation: Ann Plast Surg. 1991 Oct;27(4):351-4
references.pmid: 1663325
references.citation: J Clin Oncol. 2009 Nov 10;27(32):5325-30
references.pmid: 19805680
references.citation: Plast Reconstr Surg. 2009 Sep;124(3):752-764
references.pmid: 19342994
references.citation: J Plast Reconstr Aesthet Surg. 2012 Nov;65(11):1474-80
references.pmid: 22841854
references.citation: J Clin Oncol. 2010 Jan 1;28(1):173-80
references.pmid: 19884555
references.citation: J Natl Cancer Inst Monogr. 1994;(16):177-82
references.pmid: 7999462
references.citation: Ann Plast Surg. 2008 May;60(5):510-3
references.pmid: 18434824
references.citation: J Am Coll Surg. 2006 Nov;203(5):704-14
references.pmid: 17084333
references.citation: Plast Reconstr Surg. 2001 Jun;107(7):1710-6
references.pmid: 11391189
references.citation: J Obstet Gynaecol Can. 2007 Jan;29(1):45-60
references.pmid: 17346477
references.citation: Ann Surg Oncol. 2012 Feb;19(2):560-6
references.pmid: 21792509
references.citation: Plast Reconstr Surg. 2001 Jun;107(7):1702-9
references.pmid: 11391188
references.citation: Ann Plast Surg. 2007 Oct;59(4):359-63
references.pmid: 17901723
references.citation: J Plast Reconstr Aesthet Surg. 2006;59(1):16-26
references.pmid: 16482786
references.citation: Aesthet Surg J. 2011 Mar;31(3):310-9
references.pmid: 21385742
references.citation: Plast Reconstr Surg. 2012 Nov;130(5):984-990
references.pmid: 22777039
references.citation: Plast Reconstr Surg. 2012 Nov;130(5 Suppl 2):95S-103S
references.pmid: 23096993
references.citation: Breast Cancer Res Treat. 2000 Apr;60(3):267-75
references.pmid: 10930115
references.citation: Rozhl Chir. 2012 Jul;91(7):373-7
references.pmid: 23078255
references.citation: J Surg Oncol. 2010 Mar 1;101(3):209-16
references.pmid: 20082354
references.citation: Plast Reconstr Surg. 2010 Jul;126(1):1-11
references.pmid: 20595827
references.citation: Plast Reconstr Surg. 1996 Feb;97(2):364-72
references.pmid: 8559819
references.citation: J Clin Nurs. 2009 Feb;18(4):613-9
references.pmid: 18803576
references.citation: Br J Plast Surg. 2003 Oct;56(7):674-83
references.pmid: 12969666
references.citation: Plast Reconstr Surg. 1995 Oct;96(5):1111-5; discussion, 1116-8
references.pmid: 7568487
references.citation: Plast Reconstr Surg. 2006 Sep 15;118(4):832-839
references.pmid: 16980843
references.citation: Eur Arch Psychiatry Clin Neurosci. 2008 Apr;258(3):165-70
references.pmid: 18000636
references.citation: Cancer. 2010 Mar 1;116(5):1184-91
references.pmid: 20087962
references.citation: Tumori. 2003 May-Jun;89(3):288-91
references.pmid: 12908785
references.citation: CMAJ. 2011 Dec 13;183(18):2109-16
references.pmid: 22065359
references.citation: J Natl Compr Canc Netw. 2003 Apr;1(2):148-88
references.pmid: 19768876
references.citation: Plast Reconstr Surg. 2012 Nov;130(5 Suppl 2):57S-66S
references.pmid: 23096987
references.citation: Plast Reconstr Surg. 2011 Dec;128(6):1170-1178
references.pmid: 22094736
references.citation: J Am Coll Surg. 2011 Dec;213(6):800-5
references.pmid: 21958509
references.citation: Eur Rev Med Pharmacol Sci. 2012 Nov;16(12):1729-34
references.pmid: 23161048
references.citation: Ann Surg Oncol. 2008 Dec;15(12):3396-401
references.pmid: 18923874
references.citation: Plast Reconstr Surg. 2001 Feb;107(2):338-41
references.pmid: 11214047
references.citation: Plast Reconstr Surg. 2011 Jun;127(6):2232-2244
references.pmid: 21617458
references.citation: Ann Surg Oncol. 2012 Oct;19(11):3402-9
references.pmid: 22526909
references.citation: Plast Reconstr Surg. 2011 Jun;127(6):2245-2254
references.pmid: 21617459
references.citation: Plast Reconstr Surg. 2011 Nov;128(5):411e-418e
references.pmid: 22030501
references.citation: Surgery. 2012 Sep;152(3):382-8
references.pmid: 22739071
references.citation: Oncol Nurs Forum. 2008 Mar;35(2):189-96
references.pmid: 18321830
references.citation: Plast Reconstr Surg. 2012 Aug;130(2):263-270
references.pmid: 22495206
references.citation: Plast Reconstr Surg. 2009 Aug;124(2):395-408
references.pmid: 19644254
references.citation: Ann Chir Plast Esthet. 2013 Feb;58(1):35-40
references.pmid: 23158103
references.citation: J Plast Reconstr Aesthet Surg. 2012 Oct;65(10):e267-80
references.pmid: 22633392
references.citation: Eur J Surg Oncol. 2012 Jan;38(1):25-30
references.pmid: 21963981
references.citation: Am J Surg. 2003 Feb;185(2):114-7
references.pmid: 12559439
references.citation: Eur J Surg Oncol. 2012 May;38(5):382-9
references.pmid: 22425137
references.citation: Arch Surg. 2008 Jan;143(1):38-45; discussion 45
references.pmid: 18209151
references.citation: Plast Reconstr Surg. 1985 Nov;76(5):713-8
references.pmid: 4059412
references.citation: Clin Radiol. 2012 Feb;67(2):128-33
references.pmid: 21911216
references.citation: Ann Surg Oncol. 2012 Oct;19(10):3223-9
references.pmid: 22878610
references.citation: Plast Reconstr Surg. 2012 Jan;129(1):28-41
references.pmid: 22186498
references.citation: Am Surg. 2009 Jul;75(7):551-6; discussion 556-7
references.pmid: 19655597
references.citation: Plast Reconstr Surg. 2001 Jul;108(1):78-82
references.pmid: 11420508
references.citation: Plast Reconstr Surg. 2011 Jun;127(6):2501-2503
references.pmid: 21617483
references.citation: Ann Surg Oncol. 2008 May;15(5):1341-7
references.pmid: 18256883
references.citation: Plast Reconstr Surg. 2005 Oct;116(5):1278-86
references.pmid: 16217468
references.citation: Am Surg. 2008 Oct;74(10):902-5
references.pmid: 18942610
references.citation: Ann Surg. 1995 Jun;221(6):756-64; discussion 764-6
references.pmid: 7794079
references.citation: Plast Reconstr Surg. 2008 Aug;122(2):340-347
references.pmid: 18626348
references.citation: Plast Reconstr Surg. 2011 Nov;128(5):403e-410e
references.pmid: 22030500
references.citation: Cancer Nurs. 2012 Sep-Oct;35(5):E10-6
references.pmid: 22067694
references.citation: Eur J Surg Oncol. 2012 May;38(5):375-81
references.pmid: 22421530
references.citation: Plast Reconstr Surg. 2006 Sep 15;118(4):825-831
references.pmid: 16980842
references.citation: Br J Plast Surg. 1997 Jul;50(5):322-30
references.pmid: 9245865
references.citation: Plast Reconstr Surg. 2012 Aug;130(2):254e-264e
references.pmid: 22842422
references.citation: J Clin Oncol. 2008 Aug 20;26(24):3943-9
references.pmid: 18711183
references.citation: Plast Reconstr Surg. 2009 Aug;124(2):345-353
references.pmid: 19644246