Abstract

Objectives: Assess the applicability, clinical utility, and feasibility of a Mexico-adapted digital decision algorithm for post-mastectomy breast reconstruction through a critical narrative review and a institutional retrospective validation under public-sector constraints. Introduction: Breast reconstruction after mastectomy is essential to function, body image, and psychosocial well-being. International algorithms (NCCN/ASPS/ESMO) exist, but Mexico's public system face barriers-waitlists, workforce shortages, limited ADMs, scarce microsurgery, high use of adjuvant radiotherapy, and prevalent comorbidities-often driving choices more than individualized assessment. We propose to develop and validate an interactive, evidence-based algorithm tailored to Mexico to guide rational, multidisciplinary selection, standardize care, improve outcomes, and advance equitable access. Materials / method: Observational, retrospective cross-sectional study at Instituto Jalisciense de Cirugía Reconstructiva "Dr. José Guerrerosantos" (Mexico) including mastectomy patients with breast reconstruction (2023-2024). Charts were reviewed and echa case re-evaluated with a Mexico-adapted digital decision algorithm based on international guidelines. The algorithm's recommendation was compared with the performed technique (total/partial/non-concordant). Variables: age, BMI, mastectomy type, adjuvant RT, comorbidities, timing, technique, availabilty, shared decision-making. IRB approved; no identifiers. Results: We analyzed 30 post-mastectomy reconstructions at a public secondary hospital (mean age 50.6; BMI 28.9). Delayed vs immediated: 86.7% vs 13.3% (median delay 36.5 months). Techniques: prosthetic 60.0%m latissimus dorsi flap 36.7%, DIEP 3.3%, ADM/mesh access 5.9%. Algorithm concordance (n=28): total 92.9%, partial 7.1%, none 0%. Findings support feasibility and real-world alignment, enabling standardization and resoruce-aware decisions. Conclusion: The proposed clinical algorithm is a viable, context-adapted, and effective tool for post-mastectomy breast reconstruction in resource.limited public settings. In a 30-case preliminary validation, it showed high concordance with real practice, demonstrating alignment of evidence with local constraints to standardize decisions, optimization resources, and strengthen equity and quality of oncologic care. Next steps: multicenter validation and real-time deployment.