Abstract
The options for post-mastectomy breast reconstruction have increased considerably over the past 50 years and depend on the resultant disfigurement from surgery and or radiotherapy. Radical and modified radical mastectomy were considered the acceptable treatment for breast cancer until the mid-1970's and would often be followed with post-mastectomy radiotherapy. This presented a major challenge for reconstructive surgeons because of limited surgical options, but as the approach to the management of breast cancer became less aggressive and a therapeutic dose of radiotherapy was fractionated the reconstructive ladder expanded. Where post-mastectomy skin flaps were healthy and radiotherapy was not planned, the introduction of breast implants and saline-filled expanders enabled less traumatic immediate, delayed and revisional reconstructions. Controversies continue to follow the history of implantable breast implants, but polyurethane covered implants have a historically proven advantage over silicone shelled implants, with a significant reduction in the rate of capsular contracture. An understanding of the axial vascular supply of local and regional flaps, and the vascular territories of free flaps, dramatically improved the opportunity to more closely restore breast shape and form using composites of healthy tissue. The technique for harvesting of autologous fat graft and the appropriate use of acellular dermal matrix products has further improved the outcomes. Contemporary breast cancer management has become an inter- and multi-disciplinary specialty, and reconstructive outcomes will more likely result in remarkable symmetry of size, shape and volume of the breast reconstruction. This paper describes the chronology and variety of options that became available to selected breast cancer patients for reconstruction in the United Kingdom over the course of 50 years.