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Abstract Breast reconstruction after mastectomy is considered an important part of breast cancer overall treatment to restore the patient`s psychological and physical well-being. In the last 30 years, breast reconstruction has progressed from a rarely requested procedure to an integral part of patient management. Breast reconstruction requires a multidisciplinary team which include general surgeon, plastic surgeon, medical oncologist and radiation oncologist. The reconstructive surgeon provides valuable input on the appropriate timing and techniques for reconstruction. Factors that need consideration prior to embarking upon a reconstruction include cancer stage, patient comorbidities, possible adjuvant radiotherapy, availability of autologous tissue, and most importantly, the patient’s own desires. Autologeous reconstruction involves the transfer of myocutaneous flaps as pedicled flaps or free flaps, these include latissimus dorsi flap, pedicled TRAM flap and free TRAM flap. Perforator flaps represent the newest generation of free flap reconstruction. The skin island and accompanying fat are isolated on perforating vessels that come through muscle from the source artery, leaving intact innervated muscle. These include DIEP, SIEA, superior and inferior gluteal flaps, upper thigh flaps (TUG, PAP). There are numerous options for immediate and delayed breast reconstruction and all appear oncologically safe. There is still a paucity of long term-data on ADM assisted implant-based and perforator flap based reconstructions as well as contradictory results from different studies, reflecting lack of an agreed quality of life internationally, and poor correlation between preoperative counselling and postoperative satisfaction |