A New Decade in Breast Reconstruction

Geoffrey L. Robb, M.D., F.A.C.S.

Michael J. Miller, M.D., F.A.C.S.

Breast reconstruction has been firmly established as a legitimate part of cancer treatment-a fact attested by the Women's Health and Cancer Rights Act of 1998, which mandated nationwide coverage by third-party payers for all stages of reconstruction as well as procedures on the opposite breast to achieve symmetry. It is an important contribution from our surgical specialty to women's health.

This edition of Seminars in Plastic Surgery is dedicated to breast reconstructive surgery. It contains a set of articles dealing with a broad range of issues relevant to current practice. The first article contains a fascinating historical perspective describing the evolution of breast reconstructive surgery and documenting important technical advances, improved outcomes, and greater acceptance by the oncology community. Next, several articles provide updates on the technical aspects of each method of breast reconstruction, ranging from the use of breast implants alone to microvascular autologous reconstruction using perforator flaps. Two articles consider the role and suitable methods of breast reconstruction in patients with more advanced disease requiring adjuvant cancer treatments or procedures for the chest wall. An important article addresses the psychosocial impact of breast reconstruction and how we can improve our efforts to document outcomes in this age of evidence-based medicine and surgery. Finally, three articles deal with the practice of breast reconstruction. One offers practical suggestions for effectively educating women who are considering breast reconstruction and assisting them to make informed choices. One describes current practice patterns in North America and offers suggestions for how we might ensure reconstructive surgery is more readily available in the future. In the last article, a group of surgeons working in a private practice setting offer practical suggestions for how to successfully build breast reconstruction into routine clinical practice, with the ability to offer a full range of options to the patient to achieve the best results.

We are grateful to each author who contributed to this issue of Seminars in Plastic Surgery. We encouraged each to offer practical information that can be applied by every plastic surgeon to enhance their practice and benefit our patients.