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Recommendation
Breast reconstruction – Surgery timing and technique options
Before a mastectomy is performed, discuss the benefits and risks of all reconstruction options with reference to timing (immediate or delayed), technique (implant-based or tissue-based reconstruction) and breast symmetrising procedures, regardless of whether these procedures are available locally, and implications for future surveillance. Be aware that some patients may prefer not to have breast reconstruction surgery, and some may prefer to discuss reconstruction later.
Offer both breast reconstruction options to women (immediate reconstruction and delayed reconstruction), whether or not they are available locally. Be aware that some women may prefer not to have breast reconstruction surgery
Discuss the benefits and risks of immediate breast reconstruction and delayed breast reconstruction with women. Topics to discuss include those in table 1 and:
- the timing of breast reconstruction surgery (at the same time as mastectomy or later)
- different breast reconstruction surgery options and what they involve
- how the timing of breast reconstruction surgery affects the options available
- the uncertainty over long‑term outcomes in women having radiotherapy
Breast reconstruction should be available to all women requiring mastectomy (strength of recommendation: strong (V,A))
Immediate breast reconstruction should be offered to the vast majority of patients, except for those presenting with inflammatory breast cancer (strength of recommendation: strong (V,A))
Not appropriate to perform a mastectomy without first discussing with the patient the options of immediate or delayed breast reconstruction
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How this guidance was developed
This recommendation was adapted from the NICE 2018 guidelines (UK). Two source recommendations were merged by the EWG. Both source recommendations were based on a systematic review conducted to September 2017 with one using wording (‘Offer’) indicative of a strong recommendation and one using wording (‘Discuss’) indicative of a conditional recommendation (using GRADE methods) by the source guideline authors. The source recommendation was adapted by making it less directive, by replacing 'offer' with 'discuss', and by expanding the population from 'women' to 'all patients’.
This recommendation aligns with the 2017 Cancer Australia Statement – Influencing best practice in breast cancer: Practice 11.
The recommendation is also supported by several more recent recommendations in the ESMO (2019) clinical practice guidelines for early breast cancer.
Breast reconstruction – Surgery timing and technique options
Recommendation
Before a mastectomy is performed, discuss the benefits and risks of all reconstruction options with reference to timing (immediate or delayed), technique (implant-based or tissue-based reconstruction) and breast symmetrising procedures, regardless of whether these procedures are available locally, and implications for future surveillance. Be aware that some patients may prefer not to have breast reconstruction surgery, and some may prefer to discuss reconstruction later.
Principles in action
Patient-centred care
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Supportive care
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Communication
Useful Links
This recommendation was adapted from the NICE 2018 guidelines (UK). Two source recommendations were merged by the EWG. Both source recommendations were based on a systematic review conducted to September 2017 with one using wording (‘Offer’) indicative of a strong recommendation and one using wording (‘Discuss’) indicative of a conditional recommendation (using GRADE methods) by the source guideline authors. The source recommendation was adapted by making it less directive, by replacing 'offer' with 'discuss', and by expanding the population from 'women' to 'all patients’.
This recommendation aligns with the 2017 Cancer Australia Statement – Influencing best practice in breast cancer: Practice 11.
The recommendation is also supported by several more recent recommendations in the ESMO (2019) clinical practice guidelines for early breast cancer.