title: Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference.
abstract: BACKGROUND
  Multiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting.
  
  
  METHODS
  The conference mission statement was to "reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care." The goal was to develop a toolbox of recommendations to reduce the variability of reoperation rates and improve cosmetic outcomes. Conference participants included providers from multiple disciplines involved with breast cancer care, as well as a patient representative. Updated systematic reviews of the literature and invited presentations were sent to participants in advance. After topic presentations, voting occurred for choice of tools, level of evidence, and strength of recommendation.
  
  
  RESULTS
  The following tools were recommended with varied levels of evidence and strength of recommendation: compliance with the SSO-ASTRO Margin Guideline; needle biopsy for diagnosis before surgical excision of breast cancer; full-field digital diagnostic mammography with ultrasound as needed; use of oncoplastic techniques; image-guided lesion localization; specimen imaging for nonpalpable cancers; use of specialized techniques for intraoperative management, including excisional cavity shave biopsies and intraoperative pathology assessment; formal pre- and postoperative planning strategies; and patient-reported outcome measurement.
  
  
  CONCLUSIONS
  A practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes.
authors.affiliation: Gundersen Health System Norma J. Vinger Center for Breast Care, La Crosse, WI, USA, jlanderc@gundersenhealth.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Landercasper
authors.forename: Deanna
authors.initials: D
authors.lastname: Attai
authors.forename: Dunya
authors.initials: D
authors.lastname: Atisha
authors.forename: Peter
authors.initials: P
authors.lastname: Beitsch
authors.forename: Linda
authors.initials: L
authors.lastname: Bosserman
authors.forename: Judy
authors.initials: J
authors.lastname: Boughey
authors.forename: Jodi
authors.initials: J
authors.lastname: Carter
authors.forename: Stephen
authors.initials: S
authors.lastname: Edge
authors.forename: Sheldon
authors.initials: S
authors.lastname: Feldman
authors.forename: Joshua
authors.initials: J
authors.lastname: Froman
authors.forename: Caprice
authors.initials: C
authors.lastname: Greenberg
authors.forename: Cary
authors.initials: C
authors.lastname: Kaufman
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Barbara
authors.initials: B
authors.lastname: Pockaj
authors.forename: Melvin
authors.initials: M
authors.lastname: Silverstein
authors.forename: Lawrence
authors.initials: L
authors.lastname: Solin
authors.forename: Alicia
authors.initials: A
authors.lastname: Staley
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
authors.forename: Lee
authors.initials: L
authors.lastname: Wilke
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Hiram
authors.initials: H
authors.lastname: Cody
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D003226:Congresses as Topic; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental / Q000592:standards*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D018787:Radiation Oncology / Q000592:standards*; D012086:Reoperation; D012955:Societies, Medical; D066231:Surgeons