Conceptual considerations in breast reconstruction.

As the therapy for breast cancer evolves, the plastic surgeon must consider the type of mastectomy, the stage of disease, the timing of operations, and the use of adjunctive therapy to continue to provide the best reconstructive option to the patient. All reconstructive results are judged by comparison to the opposite breast, which sometimes should be improved with a conservative reduction or mastopexy. The timing of secondary procedures should be appropriate to avoid interference with adjuvant therapy and provide a lasting result. The plastic surgeon also must be able to follow the reconstructed breast, recognize the pattern of local recurrence, and offer reconstructive options should the therapy require additional resection.