Dutch breast reconstruction guideline

Abstract

Treatment of breast cancer is complex and multidisciplinary by nature, with protocols that are updated continuously. During preoperative multidisciplinary team meetings, regularly there is discussion between team members regarding optimal timing and type of breast reconstruction, due to conflicting interests of oncological and reconstructive treatments. Therefore, a multidisciplinary, evidence-based guideline for breast reconstruction in women undergoing breast conserving therapy or mastectomy for breast cancer, or following prophylactic mastectomy was developed by a multidisciplinary working group. The guideline was drafted in accordance with the AGREE II instrument, designed to assess the quality of guidelines with broad international support. For the recommendations, scientific evidence was considered together with other key aspects, such as working group member expertise, patient preferences, costs, availability of facilities and/or organizational aspects. Recommendations provide an answer to the primary questions, and are based on the best scientific evidence available together with the most important considerations by the working group. In accordance with the GRADE method, the level of scientific evidence and the importance given to considerations by the working group jointly determined the strength of the recommendation. The guideline aims to provide practical guidance for plastic surgeons and other members of the multidisciplinary breast cancer team. The implementation of the present breast reconstruction guideline may contribute to optimizing the delivery of care and support for breast reconstruction patients, it may stimulate evidence-based plastic surgery, it may reduce undesirable variation in clinical practice between health care providers, and improve the overall quality of life of breast reconstruction patients.

Keywords: breast reconstruction; evidence-based medicine; guideline; outcomes.