How would you approach a patient with a 12 mm recurrence of the left implant-based breast reconstruction 17 years after her initial diagnosis?

You haven't indicated what prior Rx the patient has received. Assuming no prior RT, I would radiate the chest wall, probably skip the nodes, and add hormonal therapy again, depending on what she has received in the past.

I don't get a warm fuzzy feeling about SLNB in the setting of prior reconstruction because the nodal drainage pattern has been disrupted and can be unpredictable; this is the context where we see an increase in direct drainage to SCV nodes, or even the contralateral axilla, but you have indicated th...

I would favor chest wall RT to 40 in 15 fractions with a possible boost at the site of recurrence. I would skip RNI if snln is mapped and is negative.