Table 1. Prepectoral perioperative considerations.

Condition	Potential consequence
Peripheral arterial disease	Alteration of skin flap perfusion
Diabetes	Alteration of skin flap microcirculation
Preoperative radiation	Alteration of skin flap microcirculation
Current or recent smoking	Alteration of skin flap microcirculation
Obesity (BMI >35)	Alteration of skin flap microcirculation
Immunosuppression	Delayed wound healing
Steroid use	Delayed wound healing, decreased dermal thickness
Connective tissue disorders (Ehlers-Danlos, etc.)	Delayed wound healing
Tumor location (invading chest wall or within 5 mm of pectoralis major)	Reconstruction interfering with detection of recurrence
Inflammatory breast cancer, stage IV cancer, axillary adenopathy or metastasis	Need for more aggressive therapy and consideration to avoid reconstruction altogether
Visible dermis/lack of subcutaneous fat on skin flap	Potential disruption of subdermal plexus and compromised blood flow—consider delaying reconstruction

BMI, body mass index.