ABSTRACT
Patient selection is key in terms of recommending the timings and types of breast reconstructive procedures. Skin-sparing mastectomy and its careful techniques underpin the potentially excellent cosmetic outcomes associated with immediate breast reconstruction (IBR). Radiotherapy results in a greater rate of mastectomy skin flap necrosis, particularly in the case of implant-based IBR. An active area of investigation is the use of immediate, autologous IBR in the setting of post-mastectomy radiotherapy (PMRT). The highest quality evidence supporting recommending immediate autologous IBR in the context of PMRT derives from the Mastectomy and Breast Reconstruction Outcomes Consortium. Immediate autologous breast reconstruction is safe, with the greatest risk for major complications occurring in the first year after PMRT, and is the gold standard in the context of radiotherapy either neo-adjuvant or adjuvant. Immediate acellular dermal matrices-assisted direct implant breast reconstruction and the impacts of adjuvant radiotherapy on clinical outcomes and quality of life require further investigations.
