Breast reconstruction: a review.

Remarkable advances have been made in the field of breast reconstruction, especially since general surgeons, patients, and the community as a whole have become more knowledgeable and accepting. This has provided an impetus for plastic surgeons to develop better techniques, many of which are reviewed here. In general, less time now elapses between ablative and reconstructive surgery, and frequently reconstruction follows immediately. Procedures requiring fewer steps with less donor and recipient site morbidity are favored for both the mound and nipple areolar reconstruction. There is a definite trend toward submuscular implantation to minimize the negative effects of capsular contracture. With a deficiency of skin or muscle, the trend is toward using musculocutaneous flaps primarily, latissimus dorsi, and more recently the rectus abdominis flap. Occasionally, microvascular flap reconstruction is indicated for extensive chest wall defects, e.g., postirradiation injury. Reconstructed breasts are not capable of nourishment, frequently are not erogenous , and most often are not as pleasing to the eye as the contralateral breast. Yet reconstruction has, in the majority of cases, improved the quality of life for those women who have developed breast cancer and offered hope to those women in a high-risk category for developing breast cancer. To those ends, the search for the perfect breast reconstruction will continue.