{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:16:45Z","timestamp":1793125005989,"version":"4.5.0"},"reference-count":172,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ontario Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/curroncol32060357","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T07:04:52Z","timestamp":1750143892000},"page":"357","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Postmastectomy Breast Reconstruction in Patients with Non-Metastatic Breast Cancer: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline"],"prefix":"10.3390","volume":"32","author":[{"given":"Toni","family":"Zhong","sequence":"first","affiliation":[{"name":"Plastic and Reconstructive Surgery, University Health Network, Toronto, ON M5G 2C4, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0676-7416","authenticated-orcid":false,"given":"Glenn G.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7741-2199","authenticated-orcid":false,"given":"Muriel","family":"Brackstone","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada"},{"name":"Departments of Surgery and of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon G.","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada"},{"name":"Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Hanrahan","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada"},{"name":"Department of Surgery, Royal Victoria Regional Health Care Centre, Barrie, ON L4M 6M2, Canada"},{"name":"Department of Surgery, McMaster University, Hamilton, ON L8S 1C7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Miragias","sequence":"additional","affiliation":[{"name":"Patient Representative, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiaan","family":"Stevens","sequence":"additional","affiliation":[{"name":"Radiation Treatment Program, Royal Victoria Hospital, Barrie, ON L4M 6M2, Canada"},{"name":"Departments of Radiation Oncology and of Family and Community Medicine, University of Toronto, Toronto, ON M5T 1P5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9714-2782","authenticated-orcid":false,"given":"Danny","family":"Vesprini","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N 3M5, Canada"},{"name":"Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Vito","sequence":"additional","affiliation":[{"name":"Patient Representative, Port Perry, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances C.","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"},{"name":"Departments of Surgery and of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 1P5, Canada"},{"name":"Surgical Oncology Program, Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s10147-023-02347-5","article-title":"Trends and issues in clinical research on satisfaction and quality of life after mastectomy and breast reconstruction: A 5-year scoping review","volume":"28","author":"Saiga","year":"2023","journal-title":"Int. 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