Postmastectomy Breast Reconstruction in Patients with Non-Metastatic Breast Cancer: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline
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Le résumé fourni par la source
Several postmastectomy breast reconstruction techniques and procedures have been implemented, although with limited evaluation of benefits and adverse effects. We conducted a systematic review on the plane and timing of reconstruction, and on the use of nipple-sparing mastectomy, acellular dermal matrix, and autologous fat grafting as the evidence base for an updated clinical practice guideline on breast reconstruction for Ontario Health (Cancer Care Ontario). Both immediate and delayed reconstruction may be considered, with preferred timing depending on factors such as patient preferences, type of mastectomy, skin perfusion, comorbidities, pre-mastectomy breast size, and desired reconstructive breast size. Immediate reconstruction may provide greater psychological or quality of life benefits. In patients who are candidates for skin-sparing mastectomy and without clinical, radiological, and pathological indications of nipple-areolar complex involvement, nipple-sparing mastectomy is recommended provided it is technically feasible and acceptable aesthetic results can be achieved. Surgical factors including incision location are important to reduce necrosis by preserving blood supply and to minimize nerve damage. There is a role for both prepectoral and subpectoral implants; risks and benefits will vary, and decisions should be made during consultation between the patient and surgeons. In patients who are suitable candidates for implant reconstruction and have adequate mastectomy flap thickness and vascularity, prepectoral implants should be considered. Acellular dermal matrix (ADM) has led to an increased use of prepectoral reconstruction. ADM should not be used in case of poor mastectomy flap perfusion/ischemia that would otherwise be considered unsuitable for prepectoral reconstruction. Care should be taken in the selection and handling of acellular dermal matrix (ADM) to minimize risks of infection and seroma. Limited data from small studies suggest that prepectoral reconstruction without ADM may be feasible in some patients. Autologous fat grafting is recommended as a treatment for contour irregularities, rippling following implant-based reconstruction, and to improve tissue quality of the mastectomy flap after radiotherapy.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Postmastectomy Breast Reconstruction in Patients with Non-Metastatic Breast Cancer: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline
- Date Crossref
- 17/06/2025
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University Health Network Plastic and Reconstructive Surgery pays non établi dans la noticeÉtablissement de santé
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University of Toronto Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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McMaster University Department of Oncology pays non établi dans la noticeUniversité ou école supérieure
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Western University pays non établi dans la noticeUniversité ou école supérieure
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London Health Sciences Centre pays non établi dans la noticeÉtablissement de santé
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University of Ottawa Division of Plastic and Reconstructive Surgery pays non établi dans la noticeUniversité ou école supérieure
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Ottawa Hospital Department of Surgery pays non établi dans la noticeÉtablissement de santé
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Royal Victoria Regional Health Centre pays non établi dans la noticeÉtablissement de santé
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Sunnybrook Hospital Department of Radiation Oncology pays non établi dans la noticeÉtablissement de santé
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Odette Cancer Centre pays non établi dans la noticeÉtablissement de santé
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Sunnybrook Health Science Centre pays non établi dans la noticeÉtablissement de santé
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Cancer Care Ontario pays non établi dans la noticeOrganisme public
Plastic and Reconstructive Surgery — University Health Network, Department of Surgery — University of Toronto et Department of Oncology — McMaster University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.