Multicentric disease, extensive lymphovascular invasion, high tumor grade and certain immunohistochemistry phenotypes (triple negative, luminal B, Her2 overexpression, absence of estrogen receptors and high Ki67) are among other risk factors associated with a significant local recurrence rate in the NSM literature and should be pondered when establishing the indication for VAM, as well [63]. This evidence concerns the gene ESR1 and neoplasm.