Aside from prognosis, the appearance of the breast is often the first major concern to a woman who has been told she has breast cancer.  Because of this, it is an important concept that breast reconstruction is a treatment option that should be, at minimum, mentioned to anyone diagnosed with breast cancer, especially to the woman who has been recommended to undergo mastectomy.  Reconstructive options are also important to mention to the woman undergoing breast conserving therapy since lumpectomy and radiation therapy can sometimes leave deformities of the breast, too.  In addition, the woman with large breasts diagnosed with breast cancer may benefit from a lumpectomy in the form of a breast reduction. 

A second important concept in breast reconstruction is that breast reconstruction does not change the risk of a recurrence, nor does it obscure the detection of a recurrence.  In fact, sometimes it is easier to detect a recurrence in a woman who has had reconstruction , particularly one reconstructed with an implant. 

A third important concept in reconstructive breast surgery is that, while being a positive step to help the post-mastectomy patient begin to recover both physically and emotionally, breast reconstruction has limitations and potential surgical risks that must be fully understood by the patient.  Furthermore, a reconstructed breast is never more than an approximation of the removed breast:  Realistic expectations are the key to satisfaction!!!

A fourth important concept in breast reconstruction is that breasts are paired organs and staged procedures are required to get the best results.  These steps are 1) to create a mound, 2) to design a nipple areola complex, and  3) to attain opposite breast symmetry. 

To construct a breast mound, there are three major techniques:

1.  One technique is that which uses available local tissues such as placement of an implant or tissue expander followed by replacement with a permanent implant.  Implants are available in various sizes, shapes and texures to suit the patient's physical needs and the plastic surgeon's preferences.  They are also available in both saline and silicone.

2.  Another technique to create a mound is that which uses distant tissue on a vascular pedicle such as the latissimus dorsi flap or the TRAM flap.  Flaps can usually be shaped more easily to provide a more natural appearance. 

3.  The more recent operative procedures in mound reconstruction use microvascular techniques - using the vascular supply from the lower abdominal skin and fat (similar to the TRAM), or from the buttock tissue (called the gluteal flap).

Nipple/areola reconstruction is the "icing on the cake" and can make a "mound" look like a true breast instead of a knee cap.

Because breasts are paired, even a perfectly reconstructed breast may not look good if something is not done to the opposite breast.  The perfect mound-shaped breast will do well with an implant or flap.  The drooping or large breast does not lend itself well to any unilateral procedure.  Breast lifting or reduction can provide better symmetry.

Because breast cancer in one breast can increase the risk of breast cancer in the opposite breast, prophylactic mastectomy with bilateral reconstruction may be an option for some women for both improved symmetry as well as reduced cancer risk.

While breast reconstruction can effectively "rebuild" a woman's breast, it is only an approximation of a breast, and the results are highly variable.  A reconstructed breast will not have the same sensation and feel as the breast it replaces.  Visible scars will always be present on the breast, whether from reconstruction or mastectomy.  In addition, flap techniques will leave donor scars, although usually located in less exposed areas of the body such as the  abdomen, back, or buttocks.