Breast Cancer Reconstruction Surgery (Immediate and Delayed) Across Ontario: Patient Indications and Appropriate Surgical Options

Guideline Objective

• To provide clinical guidance with respect to suitability for breast reconstruction, timing of reconstruction, and optimal reconstruction techniques.
• To make recommendations that will inform decisions at the policy and administration level aimed at improving the quality of life of women with breast cancer in Ontario.

Patient Population

• Women who have been diagnosed with breast cancer who have chosen or been recommended for therapeutic mastectomy.
• Women who are at high risk for breast cancer who have chosen or been recommended for prophylactic mastectomy.

Intended Guideline Users

General surgeons practicing breast cancer surgery, plastic surgeons, oncologists, administrators, other referring physicians, and oncology healthcare professionals (e.g. those involved in patient education or psychosocial programs).

Research Question(s)

1. Who is a candidate for postmastectomy breast reconstruction (PMBR)? Which patient, cancer, and treatment factors can affect the outcomes of breast reconstruction?
2. a) What is the appropriate timing of breast reconstruction (immediate versus [vs.] delayed) for patients who do not require radiotherapy?
   b) What is the appropriate timing of breast reconstruction for patients who are expected to require radiotherapy?
3. a) What is the outcome of skin-sparing mastectomy (SSM) compared with non-SSM?
   b) What is the outcome of nipple-sparing mastectomy (NSM) compared with non-NSM?
4. What are the risks and benefits associated with implant-based, autologous flap (i.e., deep inferior epigastric perforator [DIEP], transverse rectus abdominis myocutaneous [TRAM], superficial inferior epigastric artery [SIEA]) and combination (i.e., latissimus dorsi [LD] flap with implant) breast reconstruction?
5. What are the benefits and risks of using acellular dermal matrix (ADM) in implant-based breast reconstruction?
6. What are the benefits and risks of autologous fat grafting as an adjunct to breast reconstruction?
7. Should women who have undergone PMBR receive routine screening for recurrence?