[Historical evolution of breast reconstruction]

Breast reconstruction forms an essential part of the treatment of mastectomised women. Although the first attempts to reconstruct a breast date back to the end of the XIX century, it was not until the 1970s that there was a progressive development of the different techniques employed today. Until the 1970s, breast reconstruction was not popular, mainly because the teachings of Halsted, who believed that plastic surgery interfered with the local control of the cancer. When it was found that breast reconstruction did not have a negative influence on the neoplastic disease, but was instead of transcendental importance for the physical and psychological rehabilitation of the patient, its development benefited from several advances: the tendency towards less aggressive mastectomy techniques, which facilitate cutaneous covering; the introduction and progress of silicone breast prostheses; the submuscular implantation of the prostheses, which avoid local complications; the technique of breast tissue expansion; and great advances in the anatomical understanding of the different available flaps, especially musculocutaneous ones and those transferred microsurgically. Today the mastectomised patient can be offered reconstruction either using a silicone prosthesis or a completely autogenous reconstruction; the most recent advance is the introduction of microsurgical perforator flaps.