Current surgery for breast cancer: reconstruction methods after conservative operations and after mastectomy

Background: Breast cancer is the most common cancer affecting women and the majority of cases require surgical treatment. In the last few decades evidence-based medicine allowed surgeons to develop methods requiring less extensive surgery. Even three decades ago, every case was treated by dissecting the whole breast along with the pectoralis major muscle, pectoralis minor muscle and the axillary lymph nodes. Today we treat more than half of patients by removing only part of the breast. And when dissecting the whole breast, we can often spare the skin envelope. Conclusions: Upon tumor removal many cases require breast reconstruction in order to retain the normal appearance of the breast. The evolution of breast reconstruction can be studied in two domains: after partial removal of the breast and after complete removal of the breast, each with its own methodologic requirements and different spectrum of complications. The reconstruction results have been improving in both domains. Radiotherapy is obligatory with partial breast dissection but also often required with complete breast dissection. The esthetic results of immediate breast reconstruction after complete removal of the breast tend to be worse in cases requiring radiotherapy. For that reason the majority of authors recommend delayed reconstruction.