Breast Reconstruction Guidelines

Current Standard Approaches for Breast Reconstruction

The National Comprehensive Cancer Network recommends breast reconstruction following mastectomy typically involves either implant-based procedures or autologous tissue transplantation, with some approaches combining both implants and autologous tissue 1, 2
The National Comprehensive Cancer Network suggests oncoplastic techniques can extend breast-conserving surgical options when resection alone would yield unacceptable cosmetic outcomes 3
Reconstruction can be immediate or delayed, with many reconstructions involving a staged approach requiring multiple procedures, including surgery on the contralateral breast for symmetry, revision surgery, and nipple and areola reconstruction 1, 4, 5

The American Cancer Society states that the goals of any breast surgical procedure are total removal of malignant tissue with minimal cosmetic deformity, with proper skin incision placement critical for cosmesis 6
Meticulous hemostasis is crucial to avoid hematoma formation, which can complicate postoperative evaluation, as recommended by the American Cancer Society 6

The National Comprehensive Cancer Network recommends primary lesions should be excised with a rim of grossly normal tissue, avoiding excessive sacrifice of breast tissue, and specimen orientation by the surgeon is important for accurate margin assessment 6
For mastectomy patients, skin-sparing approaches should be performed by experienced breast surgery teams working in a coordinated, multidisciplinary fashion, as suggested by the National Comprehensive Cancer Network 2

The National Comprehensive Cancer Network recommends that for breast reconstruction, the established approaches using implants and/or autologous tissue remain the standard of care, with autologous tissue reconstruction preferred over tissue expanders/implants for patients with previous radiation due to lower risk of complications 1, 2, 4, 5
Immediate reconstruction is contraindicated for inflammatory breast cancer due to high recurrence risk and need for prompt postoperative radiotherapy, as stated by the National Comprehensive Cancer Network 2, 5
Nipple-sparing procedures should be limited to carefully selected patients with early-stage, biologically favorable cancers located >2cm from the nipple, according to the National Comprehensive Cancer Network 2, 4