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Practice Point
Breast reconstruction – Tissue-based reconstruction
For patients who are contemplating delayed breast reconstruction, and who have had chest wall radiation therapy, tissue-based reconstruction is preferred.
Autologous tissue versus implant-based reconstruction: a. Women treated by mastectomy should be made aware that autologous tissue reconstruction and implant-based reconstruction are options for immediate or delayed reconstruction. b. Reconstruction methods should be selected based on patient and surgeon factors, because overall patient satisfaction and willingness to recommend reconstruction to others appear to be similar between autologous tissue and tissue-expander implant (TE/I)-based reconstructions. However, if women are candidates for either reconstruction, then they should be informed that TE/I reconstruction may be accompanied by a higher risk of reconstructive failure or soft tissue infection and that there is a trend toward decreased esthetic satisfaction with TE/I reconstruction over time. c. Latissimus dorsi flap with or without implants is another option to TE/I or abdominal autologous tissue reconstruction. d. Radiation setting: For women who have received prior RT to their breast as part of BCT, mastectomy with immediate autologous tissue reconstruction is the recommended option. Current evidence suggests that reconstruction using TE/I alone may be associated with an increased risk of complications.
How this guidance was developed
This practice point was developed using an expert consensus process. A potentially relevant ungraded source recommendation was identified from the CCO 2016 guidelines (Canada) that discussed autologous tissue-based versus implant-based reconstruction. The CCO recommendation was not adopted or adapted because tissue-based reconstruction was considered the preferred option in the Australian health care context.
Breast reconstruction – Tissue-based reconstruction
Practice Point
For patients who are contemplating delayed breast reconstruction, and who have had chest wall radiation therapy, tissue-based reconstruction is preferred.
Principles in action
Patient-centred care
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Discuss out of pocket costs
This practice point was developed using an expert consensus process. A potentially relevant ungraded source recommendation was identified from the CCO 2016 guidelines (Canada) that discussed autologous tissue-based versus implant-based reconstruction. The CCO recommendation was not adopted or adapted because tissue-based reconstruction was considered the preferred option in the Australian health care context.