TABLE 1.
Clinical factors to consider when deciding the timing and method of reconstruction
| Clinical factor |
Guidance according to reconstruction type
|
||
|---|---|---|---|
| Immediate | Delayed | Evidence* | |
| Cancer-related factors | |||
| Ductal carcinoma in situ | Acceptable | Acceptable | Moderate |
| T1 or T2 tumours | Acceptable | Acceptable | Moderate |
| T3 or T4 | Not recommended | Acceptable | Moderate |
| Inflammatory breast cancer | Not recommended | Acceptable | Insufficient |
| Multicentric tumours | Acceptable | Acceptable | Insufficient |
| Suspicious, palpable axillary nodes | Not recommended | Acceptable | Insufficient |
| Positive premastectomy SLNB | Not recommended | Acceptable | Moderate |
| Treatment-related factors | |||
| Previous radiotherapy | Acceptable; favours autologous | Acceptable; favours autologous | Good |
| Prophylactic mastectomy | Acceptable | Acceptable | Good |
| Additional delay to surgery >3 weeks | Not recommended | Acceptable | Insufficient |
| Previous nononcological breast surgery | Acceptable | Acceptable | Moderate |
| After preoperative systemic therapy | Acceptable | Acceptable | Good |
| Before adjuvant chemotherapy | Acceptable | Acceptable | Good |
| Before adjuvant radiotherapy | Not recommended | Acceptable | Good |
| Previous diagnostic/excisional biopsy | Acceptable, but may affect skin sparing | Acceptable | Insufficient |
| Patient factors | |||
| Older age | Acceptable, but may affect risks | Acceptable, but may affect risks | Moderate |
| Obesity | Acceptable, but may affect risks | Acceptable, but may affect risks | Moderate |
| Diabetes | Acceptable, but may affect risks | Acceptable, but may affect risks | Moderate |
| Smoking | Acceptable, but may affect risks | Acceptable, but may affect risks | Moderate |
| Patient preference | Acceptable | Acceptable | Moderate |
| Planned future pregnancy | Acceptable; favors implants | Acceptable; favours implants | Insufficient |
*
Evidence levels: good – at least one well-designed randomized controlled trial or several comparative studies; moderate – noncomparative observational studies (ie, prospective and/or retrospective cohorts); insufficient – case reports or anecdotal evidence only (recommendations were consensus based in the absence of moderate or good evidence). SNLB Sentinel lymph node biopsy