Cirurgia oncoplástica e reconstrutiva da mama: Reunião de Consenso da Sociedade Brasileira de Mastologia

Objetivo: Apesar do grande numero de publicacoes em cirurgia oncoplastica e reconstrutiva da mama, diversas questoes permanecem controversas. Assim, o objetivo desta Reuniao de Consenso, foi desenvolver um guia pratico de recomendacoes baseadas nas melhores evidencias disponiveis na literatura. Metodo: Os painelistas foram os membros da Comissao de Cirurgia Oncoplastica e Reconstrutiva da Sociedade Brasileira de Mastologia. A reuniao foi realizada em agosto de 2015 em Bento Goncalves (RS). Cada painelista recebeu e respondeu previamente um questionario com 46 itens, com base na melhor evidencia cientifica e em sua experiencia. Foi considerado consenso a concordância de 75% entre painelistas. Resultados: Houve consenso em 25 itens, dos quais para oito houve concordância de 100%. O mais importantes foram: comprometimento das margens em cirurgia oncoplastica pode ser resolvido com ampliacao de margens na maioria dos casos; tumores multifocais nao sao contraindicacao para cirurgia oncoplastica; idade >70 anos nao representa contraindicacao para uso de tecnicas oncoplasticas; reconstrucao imediata pode ser indicada com seguranca para a maioria das candidatas a mastectomia; pacientes com indicacao de radioterapia pos-mastectomia podem ser submetidas a reconstrucao imediata, devendo ter ciencia dos riscos maiores para mau resultado estetico; mastectomia com preservacao do complexo areolopapilar e segura nos casos de câncer; radioterapia apos a mastectomia com preservacao do complexo areolopapilar nao esta indicada fora dos criterios classicos de irradiacao do plastrao; tela abdominal reduz chances de hernia no caso de reconstrucao com TRAM. Conclusao: atraves desta reuniao foi possivel estabelecer importantes pontos consensuais de acordo com a opiniao dos especialistas, que poderao auxiliar os mastologistas na tomada de decisoes em cirurgias oncoplasticas e reconstrutivas da mama. Objective: Despite the large number of publications in oncoplastic and breast reconstructive surgery, several issues remain controversial. The aim of this Consensus Meeting was to develop a practical guide of recommendations based on the best evidence in the literature. Method: All panelists were members of the Oncoplastic Commission of the Brazilian Society of Mastology. The Consensus Meeting was held in Bento Goncalves (RS), in August 2015. Each panelist received and answered a questionnaire with 46 items, based on the best evidence in the literature and in their expertise. It was considered consensus the agreement of 75% between panelists. Results: There was consensus on 25 items, of which eight were for 100% agreement. The most important of these topics were: involvement of the margins in oncoplastic surgery can be solved by resection of margins in most cases; multifocal tumors is not a contraindication for oncoplastic surgery; age >70 years is not a contraindication for use of oncoplastic techniques; immediate reconstruction can be performed safely to most candidates for mastectomy; patients for post-mastectomy radiotherapy may be subject to immediate reconstruction and should be aware of the risks for poor aesthetic result; mastectomy with preservation of the nipple and areola complex is safe in cancer; radiotherapy after mastectomy with preservation of the nipple and areola complex is not indicated outside the classical criteria of irradiation chest wall; abdominal mash reduces chances of hernia in TRAM flaps. Conclusion: In this meeting it was possible to establish important consensus points according to the opinion of experts, which can help breast surgeons in their decision-making in oncoplastic and reconstructive surgery of the breast.