Breast Reconstruction Techniques: Historical Evolution and Current Surgical Practice

Breast reconstruction has become an integral component of the comprehensive management of patients undergoing mastectomy for breast cancer. Over the past decades, reconstructive techniques have evolved significantly, transitioning from simple pedicled flaps to sophisticated microsurgical procedures that aim to restore breast volume, symmetry, and patient quality of life. The objective of this review is to analyze the current therapeutic options for breast reconstruction in plastic and reconstructive surgery, emphasizing developments from 2020 to 2025, while also providing a historical overview of the principal reconstructive flaps, including their original descriptions and clinical evolution. Implant-based reconstruction and autologous tissue reconstruction using pedicled and free flaps are discussed in terms of indications, advantages, disadvantages, and associated complications. A comparative analysis of the most commonly used techniques is presented, highlighting patient selection criteria and surgical outcomes. Understanding the strengths and limitations of each reconstructive option allows the reconstructive surgeon to individualize treatment and optimize functional and aesthetic results.