**4. Who is a candidate for BR after BC surgery?**

Most women diagnosed with BC are candidates for BR which is viewed as part of the healing process. Every patient, regardless of disease stage, socioeconomic status, or demographics, must be informed about options and techniques available to them. Historically, there was a concern that BR may mask locoregional recurrence or that it may compromise adjuvant treatments [18]. However, the available evidence suggest that BR does not adversely affect disease-free or overall survival and there is no significant delay in recurrent disease presentation [19]. Currently, with improved social media and internet access, there is an increase in frequency of patients who are desiring breast reconstruction after mastectomy [20].

The multidisciplinary team should review important parameters in order to obtain a complete evaluation of any particular patient (**Figure 4**).

There is a particular group of patients who is considered high risk based on genetic mutations. Less than 15%of all BC are associated with germline mutations [21]. The majority of hereditary breast tumors are due to mutations in BrCa1 and/or


**Figure 4.**

*Breast reconstruction patient's criteria.*

#### *Breast Reconstructive Options DOI: http://dx.doi.org/10.5772/intechopen.108945*

BrCa2 genes, these patients often have bilateral and multicentric disease, early-onset, and more likely to be Triple Negative (ER-, PR-, HER2-) [22, 23]. One of the most effective strategies in treating these women is the prophylactic mastectomy better defined as Risk Reduction mastectomy (RRM). This technique provided the greatest reduction in risk of BC development (around 90%) and also diminishes the anxiety and fear in these affected women [24]. As a result of that, this subset of patients can benefit from prophylactic mastectomy, and require breast reconstruction of their affected breast as well as a restoration procedure for their contralateral breast. It should be noted that contralateral RRM does not improve survival in patients without deleterious genetic mutations or lobular histology [25]. In the USA, a growing rate of bilateral mastectomy for unilateral BC is being observed. Availability of immediate BR, young age, pathogenic BrCa mutations, significant family history, and Triple Negative disease play a significant role in choosing this type of surgery. NSM plus immediate BR is nowadays considered the gold standard in this group of women [26].
