Introduction

One in nine women in the United Kingdom will develop breast cancer.1 The surgical treatment of these patients will involve either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women, achieved by creating a breast mound that is similar in size, shape, contour, and position to the opposite breast. Women thus gain the freedom to wear a variety of clothing, without needing external breast prostheses, and have been shown to haveless psychological morbidity than those who have mastectomy without reconstruction.2

Here we review the indications, timing, principles, and techniques of breast reconstruction inpatients who need tumour ablative surgery. We concentrate predominantly on women who have had mastectomies.

Sources and selection criteria

We searched Medline and the Cochrane database search by using the term “breast reconstruction.” We reviewed abstracts and selected articles that were relevant to our review subheadings. We selected only articles written in English and those up to October 2004.

Indications for breast reconstruction

Breast reconstruction is increasingly an integral aspect of the management of patients with breast cancer. Some patients, who have had radical tumour resections, may simply need wound closure.Typically, however, breast reconstruction is an option.

Suitable candidates are those who have, or are expected to have, considerable asymmetry of thebreasts after tumour ablative surgery. The vast majority of reconstructions are therefore done inpatients having a mastectomy, who should be counselled about reconstructive options before their surgery.3 Even women with locally advanced disease may besuitable for breast reconstruction and should not be excluded.4 Contraindications include metastatic disease and anaesthetic risk factors such as significant cardiopulmonary disease.

Principles of breast reconstruction

Mastectomy involves the removal of breast tissue, varying amounts of skin, and, invariably, the nipple-areola complex. The removal of these tissues results in the loss of volume, shape, …