[Mastectomy and immediate reconstruction: Indications, techniques and decision algorithm]

Area of Science:

• Oncology
• Plastic Surgery
• Surgical Oncology

Background:

• Advances in matrix implant coverage and perforator flap techniques have expanded indications for immediate breast reconstruction.
• Adjuvant therapies can be safely administered following immediate reconstruction, improving oncological care.
• The decision-making process for immediate breast reconstruction requires careful consideration of patient morphology and comorbidities.

Purpose of the Study:

• To present an algorithm for immediate breast reconstruction following therapeutic mastectomy.
• To guide the selection of reconstruction methods (implants or flaps) based on mastectomy type and patient factors.
• To facilitate oncoplastic breast surgery in patients with infiltrating carcinomas.

Main Methods:

• Evaluation of patient morphology and comorbidities.
• Assessment of tumor location and distance from the nipple-areola complex (NAC).
• Selection of mastectomy type (conventional, skin-sparing, nipple-sparing) and reconstruction technique (implants, free/pedicled flaps).

Main Results:

• An algorithm is described to guide immediate breast reconstruction decisions.
• The approach accommodates therapeutic mastectomy with or without adjuvant radiotherapy.
• Successful reconstruction is achievable with implants or various flap techniques.

Conclusions:

• Immediate breast reconstruction is a feasible option for infiltrating breast carcinomas.
• Multidisciplinary oncological assessment is essential for optimizing patient selection and outcomes.
• Personalized surgical planning ensures the best oncoplastic approach for each patient.