Implants For Reconstruction Research Articles

Delayed Breast Implant Reconstruction

We evaluated the association between radiation therapy and severe capsular contracture or reoperation after 717 delayed breast implant reconstruction procedures (288 1- and 429 2-stage procedures) identified in the prospective database of the Danish Registry for Plastic Surgery of the Breast during the period between 1999 and 2006. A history of radiation therapy was associated with increased risk of severe capsular contracture for 1- and 2-stage procedures, with adjusted hazard ratios (HR) of 3.3 (95% confidence interval [CI]: 0.9-12.4) and 7.2 (95% CI: 2.4-21.4), respectively. Similarly, a history of radiation therapy was associated with a non-significantly increased risk of reoperation after both 1-stage (HR = 1.4; 95% CI: 0.7-2.5) and 2-stage (HR = 1.6; 95% CI: 0.9-3.1) procedures. Reconstruction failure was highest (13.2%) in the 2-stage procedures with a history of radiation therapy. Breast reconstruction approaches other than implants should be seriously considered among women who have received radiation therapy.

Extended Trimethoprim/Sulfamethoxazole Prophylaxis for Implant Reconstruction in the Previously Irradiated Chest Wall

Patients who have undergone prior chest wall irradiation can present as challenging candidates for implant reconstruction because of troublesome rates of infectious complications. The issue of antibiotic prophylaxis remains controversial, and evidence-based postoperative strategies to reduce implant infections have not been well described in the literature. The purpose of this study was to determine the efficacy of extended trimethoprim/sulfamethoxazole therapy in preventing implant infections in the irradiated chest wall. A retrospective chart review of hospital and office records was performed on all patients undergoing implant reconstruction performed by a single surgeon (J.M.S.) from August of 2005 to March of 2008. Before 2007, the senior author used 5 to 7 days of cephalosporin prophylaxis. Subsequent to this period, the prophylactic regimen was amended to provide patients with previous chest wall irradiation prophylactic trimethoprim/sulfamethoxazole for 30 days after implant insertion. Fifty-one implant reconstructions, in the setting of prior ipsilateral chest wall irradiation, were performed. The mean follow-up time was 39 months. The infection rate for the routine cephalosporin group was 35 percent as compared with 8 percent for the extended trimethoprim/sulfamethoxazole group (p = 0.038). After multivariate analysis, extended trimethoprim/sulfamethoxazole remained the only significant factor that influenced the rate of infection (p = 0.05). The mean time to infection was 13 weeks for the routine cephalosporin group and 1.5 weeks for the extended trimethoprim/sulfamethoxazole group (p = 0.044). Extended trimethoprim/sulfamethoxazole therapy demonstrates preliminary evidence as an effective adjunctive measure for reducing the rate of implant infections in breast reconstruction. Therapeutic, III.

Retrospective Review of 331 Consecutive Immediate Single-Stage Implant Reconstructions with Acellular Dermal Matrix

Immediate single-stage direct-to-implant breast reconstruction with acellular dermal matrix optimizes aesthetics by preserving the mastectomy skin envelope. The authors report trends, early complications, and costs. A retrospective review of three surgeons' experience was performed for immediate single-stage implant reconstruction with acellular dermal matrix and tissue expander reconstruction without it at Massachusetts General Hospital. Two hundred eleven patients had 331 direct-to-implant reconstructions using AlloDerm following nipple-sparing (n = 66) or skin-sparing (n = 265) mastectomy for cancer (n = 216) or prophylaxis (n = 115). The number of single-stage implant reconstructions increased from seven in 2006 to 116 in 2009. The percentage performed for prophylaxis increased from 29 percent to 41 percent. Fifty-one patients underwent preoperative (n = 33) or postoperative (n = 18) irradiation. Total complications included 10 infections (3.0 percent), five seromas (1.5 percent), four hematomas (1.2 percent), and 30 reconstructions (9.1 percent), with skin necrosis leading to five implant losses (1.5 percent). Tissue expander reconstruction without AlloDerm had a similar total complication rate (158 reconstructions) (p = 0.18), including nine infections (5.7 percent), three seromas (1.9 percent), three hematomas (1.9 percent), and 16 reconstructions (10.1 percent), with skin necrosis leading to 11 implant losses (7.0 percent). A higher complication rate occurred in the surgeons' combined first year performing single-stage implant reconstruction (21.4 percent) compared with subsequent years (10.9 percent) (p < 0.02) and in one- or two-stage reconstruction patients undergoing irradiation (p = 0.005). There was no significant difference in total overall costs (p = 0.8). Immediate single-stage implant reconstruction using acellular dermal matrix offers a cost-effective reconstruction with a low complication rate. This may be the procedure of choice in select patients. Therapeutic, III.

Perforator Flap Breast Reconstruction After Unsatisfactory Implant Reconstruction

In 2009, 86,424 breast reconstructions were performed in the United States, with 76% being implant-based procedures. Capsular contracture and infection are the 2 most cited indications for implant explantation, resulting in a reconstruction failure. However, several patients are dissatisfied with implant reconstruction even without the aforementioned complications. We hypothesize that microvascular autologous tissue transfer with perforator free-flap breast reconstruction provides an excellent salvage modality in the face of an unsatisfactory implant reconstruction, resulting in an improved cosmetic and functional outcome, with low risk of complications. We retrospectively reviewed the charts of patients in the senior author's practice who underwent perforator flap breast reconstruction between the years 1998 through 2008, and identified all patients who had prior implant reconstruction. Indications for implant explantation, medical history, operative procedure, and postoperative complications were reviewed. During the study period, 1846 perforator flaps were performed. We found 191 patients who underwent autologous breast reconstruction after implant reconstruction with a total of 284 flaps (15.4%). The most frequent patient complaint was unnatural appearance and feel of the implants (Baker I or Baker II), and the majority of patients had not undergone radiation. Most patients were reconstructed using abdominal flaps with 164 deep inferior epigastric perforators, 50 superior gluteal artery perforators, 30 superficial inferior epigastric arteries, 35 inferior gluteal artery perforators, and 5 transverse upper gracilis. The total complication rate was 7.4%, with most complications related to wound healing at the donor site. There were 3 flap losses (1%), all of which were later successfully reconstructed with another perforator flap. Implant failures are traditionally thought to be in patients with Baker grade III/IV capsular contractures and in patients status post radiation therapy. However, in our study, the majority of patients seeking perforator flap reconstruction after implant reconstruction complained of an unnatural feel and appearance of their breasts, and did not have a severe capsular contracture deformity (Baker III/IV), nor had they undergone radiation. This suggests that implant reconstruction can lead to patient dissatisfaction severe enough to warrant removal even with Baker I/II results, and not in the setting of postradiation changes.

Mastectomy, Nipple-Areola Preservation, and Immediate Implant Reconstruction: Are Total and Partial Muscle Coverage Techniques Aesthetically Equivalent?

Mastectomy, Nipple-Areola Preservation, and Immediate Implant Reconstruction: Are Total and Partial Muscle Coverage Techniques Aesthetically Equivalent?

The value of latissimus dorsi flap with implant reconstruction for total mastectomy after conservative breast cancer surgery recurrence

Total mastectomy is usually indicated after breast conservative treatment cancer recurrence. Breast reconstruction in this group can be performed with many options. We did 63 latissimus dorsi flap with implants reconstructions between 2001–2007. All of them were performed in breast cancer recurrence cases after breast conservative treatment and preceded for total mastectomy. The patient age range from 31 to 71 years old (50.1 ± 7.3 years). The follow-up was 36.5 ± 14.9 months (22–141 months). Neither flap loss nor significant major donor-site complication was recorded. The capsular contraction Baker’s grade III was observed in 2 cases (3.1%). The rest were grade I–II and there was no grade IV contracture. We purpose that LD flap with implant can be performed in irradiated breast with low capsular contracture rate. It is suitable in total mastectomy reconstruction after conservative breast cancer surgery recurrence.

Nipple-Sparing Mastectomy with Immediate Implant Reconstruction: Cosmetic Outcomes and Technical Refinements

Nipple-sparing mastectomy is gaining widespread popularity, as it could allow improved aesthetic outcome without increasing oncologic risk. To investigate the reconstructive issues experienced with immediate implant reconstruction, the authors reviewed the cosmetic outcomes of their series. The authors retrospectively analyzed the data on 33 cases of nipple-sparing mastectomy for both cancer and prophylaxis with immediate implant reconstruction using the submusculo-subfascial pocket. Cosmetic evaluation methods were clinical and photography-based assessments and a patient-satisfaction survey. The average follow-up period was 26.8 months. No nipple-areola complex cancer involvement was registered. The reconstructive outcomes ranged from good to excellent in 83 percent of the cases. Patients' satisfaction was high to very high, except in one patient who experienced total nipple-areola complex loss (one breast, 2.4 percent). Overall, early minor complications were registered in four breasts (9.5 percent) and late minor complications in five cases (12 percent). The authors' series suggest that nipple-sparing mastectomy is an option for carefully selected and screened patients. Larger studies with longer follow-up are needed, however. On the whole, the immediate one-stage implant reconstruction with hyperprojected anatomical gel implants represents a valid option. The skin incision algorithm proposed, which is based on the breast size, shape, and previous scars, might aid in the decision-making process to achieve satisfying results using this procedure. The radial approaches represent a good compromise between the oncologic and reconstructive procedures.

Skin Sparing Mastectomy with Delayed Implant Reconstruction

Skin Sparing Mastectomy with Delayed Implant Reconstruction

Surgical Results, Aesthetic Outcome, and Patient Satisfaction after Microsurgical Autologous Breast Reconstruction following Failed Implant Reconstruction

The majority of breast reconstructions are performed using implant material. Implants have some major long-term disadvantages. Long-term implant-related complications and improved microsurgical techniques have led to an increased number of women requesting conversion of their implant breast reconstruction to autologous breast reconstruction. The aim of this study was to evaluate surgical and aesthetic outcome and patient satisfaction after tertiary autologous breast reconstruction. Between 2001 and 2007, 42 women underwent 61 tertiary autologous breast reconstructions. Surgical outcome and complications were evaluated. Patient satisfaction was assessed using a study-specific questionnaire. Aesthetic result was rated by an expert panel using standardized photographs. Forty-seven deep inferior epigastric artery perforator, 10 mini-transverse rectus abdominis musculocutaneous, and four transverse musculocutaneous gracilis flaps were performed. Eight patients required reoperation because of complications (19 percent). Total flap loss did not occur. Nineteen patients underwent one or more additional operations to improve aesthetic outcome. Physical discomfort caused by implants and dissatisfaction with the aesthetic result were the main patient motivations to opt for autologous breast reconstruction. Reduction or disappearance of physical discomfort was noted in the vast majority of patients. Most patients were very satisfied with the aesthetic result (mean, 8 of 10), but the mean panel satisfaction score was lower (7 of 10). However, the panel noted a significant improvement of the aesthetic result after conversion to autologous breast reconstruction (from 5 of 10 to 7 of 10). Autologous breast reconstruction after failed implant reconstruction is a technically feasible and reliable procedure that leads to improved physical condition and aesthetic results and a high degree of patient satisfaction.

Skin-Reducing Mastectomy With Immediate Implant Reconstruction as an Indispensable Tool in the Provision of Oncoplastic Breast Services

Skin-reducing mastectomy (SRM) is a method of immediate breast reconstruction derived from a Wise breast reduction incision pattern that enables immediate subpectoral implant placement after mastectomy. Its virtue lies in the manner it provides for adequate implant coverage using muscle and a deepithelialized dermal flap, thus reducing the risk of implant extrusion and providing good inframammary contour. Our experience with this technique is elaborated. Data was collected from a prospective database in our unit from January 2006 to August 2009. Information was analyzed on indications, complications, cosmetic outcomes, and recurrence rates. A total of 89 SRMs were performed in 72 patients during the study period. This included 65 SRMs for invasive breast cancer, 7 for in-situ disease, and 17 for risk reduction. Median patient age was 44 years, and follow-up ranged from 5 to 42 months. Complications included capsular contracture in 14 patients, 2 implant infections, and 1 hematoma requiring surgical evacuation. Cosmetic outcomes were graded by patients as good to excellent in 66 (92%). No local recurrences have been detected to date. Our observations support the use of this technique as a safe, valid, and useful tool in an oncoplastic breast service.

“13-23-30” Anatomic Approach for Maxillary Full-Arch Implant Reconstruction: A Case Report and Surgical-Prosthetic Considerations

For the past 30 years, implant treatment has been advocated for partially and fully edentulous patients to improve function, esthetics, phonetics, and comfort. Patients can now benefit from removable and fixed implant-retained and implant-supported prostheses using the bone-anchoring techniques of endosseous osseointegrated implants. Much research has been done on complete maxillary implant reconstruction because of the large number of patients with edentulous maxillas and an enormous armamentarium of surgical-prosthetic implant techniques used in these cases. In the present article, one more technique is recommended, an anatomically based surgical-prosthetic approach--"13-23-30"--that should help a clinician with the initial selection of implant sites when contemplating an implant treatment of edentulous maxilla with a fixed 6-implant-supported hybrid prosthesis. This technique is based on the anatomy and function of mastication of natural dentition. The rationale behind this anatomic concept of treatment is discussed, and a case report is presented.

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

Although immediate breast reconstruction is increasingly offered as part of postmastectomy psychosocial rehabilitation, concerns remain that it may delay adjuvant therapy or impair detection of local recurrence. No single population-based study has examined the relationship between immediate breast reconstruction and breast cancer-specific survival. By using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries, breast cancer-specific survival was compared for female unilateral mastectomy patients who did or did not undergo immediate breast reconstruction. Cox proportional hazards models were fitted, adjusting for known demographic and disease severity variables and stratifying on reconstruction type (implant or autologous) and age. Improved breast cancer-specific survival was observed among all immediate breast reconstruction patients compared with patients who underwent mastectomy alone (hazard ratio [HR]=0.74; 95% confidence interval [CI], 0.68 to 0.80). Implant reconstruction patients below 50 years of age demonstrated the greatest apparent survival benefit (HR=0.47; 95% CI 0.28 to 0.80). Similarly, autologous reconstruction was associated with improved cancer-specific survival among patients below the age of 50 (HR=0.58; 95% CI, 0.42 to 0.80) and between ages 50 to 69 (HR=0.61; 95% CI, 0.43 to 0.85). Immediate breast reconstruction is associated with decreased breast cancer-specific mortality, particularly among younger women. We believe this association is more likely attributable to imbalances in socioeconomic factors and access to care than to inadequate adjustment for tumor characteristics and disease severity. Further research is needed to identify additional prognostic factors responsible for the improved cancer survival among women undergoing immediate postmastectomy reconstruction.

Issues, Considerations, and Trends in Bilateral Breast Reconstruction

Background: Indications for bilateral mastectomy, including contralateral and bilateral prophylactic mastectomy, continue to evolve. Increased demand for bilateral breast reconstruction warrants evaluation of both oncologic imperatives and outcomes specific to bilateral reconstructions. Methods: Bilateral autologous and implant-based breast reconstructions from 1990 to 2005 were analyzed and compared with cases of unilateral reconstruction. Results: A total of 3518 cases of breast reconstruction (from 1990 to 2005) were analyzed. The majority of patients (n = 2285) underwent unilateral reconstruction using abdominal free flaps (61 percent), implants alone (23 percent), latissimus flaps with or without implants (9 percent), and pedicled transverse rectus abdominis musculocutaneous flaps (5 percent). Bilateral reconstructions were primarily immediate (70 percent) for unilateral cancer with contralateral prophylactic mastectomy (69 percent). Bilateral reconstruction was achieved with implants (57 percent), free flaps (35 percent), latissimus flaps with or without implants (4 percent), and pedicled transverse rectus abdominis musculocutaneous flaps (1 percent). Flap loss rate was comparable in unilateral and bilateral groups (1.4 percent and 1.2 percent, respectively). Bilateral reconstruction increased 36 percent after 2000. From 2000 to 2005, the majority of unilateral cases were reconstructed with flaps (68 percent; implants, 32 percent), whereas the majority of bilateral cases were reconstructed with implants (62 percent; flaps, 38 percent). Perioperative complications were higher in bilateral compared with unilateral reconstructions and in autologous compared with implant reconstructions. Free flap failure rates of 1.5 percent contrasted with early (3 percent) and long-term (>5 years) implant failure rates (8 percent). Conclusions: Autologous tissues provide optimal replacement after mastectomy but carry the potential for donor-site morbidity. Implant reconstructions, although demonstrating less initial morbidity, appear to deteriorate over time. Aesthetic reconstruction of bilateral breasts imposes specific challenges that warrant further study into strategies for maximizing outcomes.

Surgical Outcomes and Nipple Projection Using the Modified Skate Flap for Nipple-Areolar Reconstruction in a Series of 422 Implant Reconstructions

Numerous techniques have been used in an attempt to achieve long-term nipple projection following nipple-areolar reconstruction (NAR). A common setback, however, is the diminution of projection over time; this phenomenon is particularly evident following implant based breast reconstruction. The purpose of this report was thus to evaluate surgical outcomes and long-term nipple projection with the use of "modified skate flap" technique in exclusively implant based postmastectomy reconstructions. A retrospective review was performed for the period between 1993 and 2007. All consecutive patients with 2-staged tissue expander/implant reconstructions followed by NAR using the modified skate flap technique performed by the senior author (P.C.) were identified in a prospectively maintained breast reconstruction database. Only patients with a minimum of 1-year follow-up were included in the study. Patients with a history of irradiation to the breast were excluded from nipple projection assessment. Clinical outcome measurements included long-term nipple projection as well as incidence of complications from the NAR procedure using the modified skate flap technique. Over the 15-year study period, 475 patients underwent 2-staged tissue expander/implant reconstruction followed by NAR using the modified skate flap technique. Of these, there was a total of 292 patients with the minimum requirement of 1-year follow-up post NAR (61% follow-up rate). The total number of reconstructed nipple areolar complexes evaluated in this series was 422 (130 bilateral and 162 unilateral NAR). Forty patients (28 unilateral and 12 bilateral NAR) who received radiation to their breasts were excluded from nipple projection assessment. At a median follow-up of 44 months (range: 12-84 months), mean nipple projection was 2.5 mm (range: 1-4 mm). Minor complications occurred in 7.2% of the patients (n = 292). Skin graft donor site dehiscence was the most common complication (3.1%) followed by partial skin graft nontake of the areola (2.1%). This report documents the largest series of NAR using a single technique in the setting of postmastectomy reconstructions. This technique can be safely performed over breast implants with acceptably low rates of complications and predictable results. Long-term nipple projection over implant reconstructions using this technique is modest and this must be forewarned to patients completing the final stage of their implant reconstruction.

Breast reconstruction following amputation for cancer

Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favourably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. Implant reconstructions were most common, 44 (52.3%), with primary reconstruction in 31 (70.4%) and secondary in 13 (29.5%) women. Lattisimus dorsi flap (LDF) and implant were utilized in 32 (38%) of the patients, with primary reconstruction in 24 (75%) and secondary in 8 (25%) women. Transversal rectus abdominis myocutaneous (TRAM) flap was rarely used -- just in 8 (9.5%) patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9%) patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9%) cases. Implant loss occurred in 5 (5.9%) cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59%) cases; very good, 20 (24%), and good, 14 (16.8%). In one case, disease progression was observed 6 months after the primary breast reconstruction. Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good in each woman.

Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Inferolateral AlloDerm Hammock for Implant Coverage in Breast Reconstruction

Implant reconstruction is commonly performed to reconstruct mastectomy defects or to correct breast hypoplasia. We have been using an inferolateral AlloDerm hammock as an inferior extension of the pectoralis major muscle to provide a mechanical barrier between the implant and skin and to control implant position. The inferior border of the AlloDerm hammock is attached inferiorly to the rectus abdominis fascia and laterally to the serratus anterior fascia to create the borders of the implant pocket. The AlloDerm is then sewn to the pectoralis major muscle to enclose the implant. The AlloDerm hammock was used in 43 patients and 67 breasts for immediate expander-implant reconstruction (10), immediate silicone implant reconstruction (30), delayed expander-implant reconstruction (4), and revisional implant reconstruction for capsular contracture following capsulectomy (23). The AlloDerm hammock allowed complete coverage of the implant and symmetric positioning of the inframammary fold. In delayed reconstructions with existing skin redundancy at the mastectomy site, inferior epigastric tissue was recruited and tissue expanders filled over 75% of the desired volume, thus decreasing the need for subsequent filling. Patients were overall satisfied with their results and had few complications. No capsular contracture, hematoma, or seroma was observed in 6 months to 3 years of follow-up. Implant reconstruction with an inferolateral AlloDerm hammock facilitates positioning of the implant in immediate or revisional breast reconstruction and simplifies expander-implant reconstruction. This safe technique is easy to learn and should be considered a viable option for breast reconstruction.

Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Although use of the latissimus dorsi myocutaneous flap associated with the Biodimensional anatomical expander implant system (McGhan 150) is a reliable technique, little information has been available regarding clinical outcome following periareolar skin-sparing mastectomy reconstruction. The purpose of this study was to analyze the feasibility of the technique, surgical planning, and its outcome following skin-sparing mastectomy. Thirty-two patients underwent immediate unilateral latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system breast reconstruction. Mean follow-up was 18 months. The technique was indicated in patients with small- or moderate-volume breasts with or without ptosis, in whom the use of abdominal flaps was precluded. Flap and donor-site complications were evaluated. Information on anesthetic results and patient satisfaction was collected. Seventy-two percent had tumors measuring 2 cm or less (T1) and 78 percent were stage 0 and I according to American Joint Committee on Cancer criteria. Breast skin complications occurred in 9.4 percent. Two patients presented small breast skin necrosis, and in one patient, a wound dehiscence was observed. Donor-site complications, all represented by seroma, occurred in 12.5 percent. The cosmetic result was considered good or very good in 84.4 percent, and the majority of patients were either very satisfied or satisfied. No local recurrences were observed. All complications except two were treated by conservative means. The latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system is a simple and reliable technique for periareolar skin-sparing mastectomy reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative and postoperative management.

Clinical Investigation of Dental Implant Reconstruction for Grafted Alveolar Cleft Patients

The purpose of this study was to evaluate the clinical application of endosseous implants for management of grafted alveolar cleft. Four patients (1 male and 3 female; mean age 26.6 years; age ranging from 21.5 to 30.4 years at first implant surgery) with unilateral cleft lip and palate were evaluated. All patients received autogenous particulate cancellous bone and marrow graft (PCBM) to close the alveolar cleft. After bone bridge formation, implant treatment was performed. All patients with insufficient alveolar bone height, chin or ramus of mandible bone, onlay grafting was performed 4 months before implant installment. A total of 5 implants were placed in the grafted alveoli. The length of implants ranged from 10.0 to 13.0 mm. The follow-up period ranged from 2.2 to 4.1 years after implant placement. The clinical result was acceptable in all patients. The survival rate of implants was 100%. Implant treatment for grafted alveolar cleft was studied and the outcome of treatment was acceptable.

Breast reconstruction with alloplastic implants

This article reviews immediate and delayed breast reconstruction with prosthetic implants, and the effect of irradiation therapy. Despite widespread use of breast conserving surgery for early breast cancer, many breast cancer patients still undergo mastectomy. Some of these patients choose breast reconstruction. Over the last 30 years, techniques for breast reconstruction have evolved significantly with new alternative techniques and improved surgical devises. Immediate or delayed breast reconstruction with silicone prosthesis can be an excellent option. Implant reconstruction may be single or two stage procedures. Traditionally, small breasts with minimal ptosis are suited for single-stage reconstruction. Large breasts or inadequate skin require expanders followed by implants. Minimal excision mastectomy and biological spacers are allowing larger breast single stage reconstruction and improved aesthetics for two stage procedures. With recent studies suggesting survival advantage of post-mastectomy irradiation, many candidates for breast reconstruction are receiving radiotherapy, which complicates healing after breast reconstruction.