Distribution of responses on treatment guidelines followed before and during the COVID surge among 1,103 respondents regarding an invasive BC after mastectomy with immediate reconstruction case 3. A 54-year-old woman underwent a total simple mastectomy with immediate tissue expander reconstruction. Pathology revealed a 3.4-cm grade 2 ER+/PR+/HER2– invasive ductal carcinoma and no lymphovascular invasion. Of three sentinel lymph nodes, one was positive (8-mm focus) without extranodal extension. Oncotype Dx recurrence score was 4. Adjuvant chemotherapy was not recommended. An adjuvant aromatase inhibitor was planned. aResponses regarding treatment recommendation are shown. BC, breast cancer; ER+, estrogen receptor–positive; HER2–, human epidermal growth factor receptor 2–negative; PMRT, postmastectomy radiation therapy; PR+, progesterone receptor–positive.