Breast reconstruction: current state of the art.

The current state of the art makes breast reconstruction possible in any patient who has undergone mastectomy, whether simple, modified radical, or radical. Indications for reconstruction are a strong desire on the part of the patient and a reasonable life expectancy. Methods of reconstruction include the simple placement of a breast prosthesis alone (submuscularly when possible) or in combination with advancement of upper abdominal skin or rotation flaps. Expander implants are useful in patients with limited skin and musculature. For the patient with serious muscle and skin deficits, more complex reconstructive procedures with use of transverse rectus abdominis or latissimus dorsi myocutaneous flaps may be performed, with or without an implant. Several methods of reconstruction of the nipple and areola are also possible. Treatment of the opposite breast is often necessary if symmetry is to be achieved. When appropriate, augmentation, mastopexy, reduction, or subcutaneous mastectomy may be performed. There is no single preferred method of reconstruction. The approach should be tailored for each patient.