Breast Reconstruction Through the Decades: a Review of Innovations and Surgical Trends.

backgroundBreast reconstruction is a fundamental component of breast cancer management, providing physical restoration and psychological support. Over the past four decades, advancements in reconstructive methods have reshaped clinical practices, shifting from implant-based to autologous techniques that prioritize patient comfort and aesthetic outcomes.

methodsThis systematic review followed PRISMA guidelines to analyze 49 studies published between 1980 and October 2024, encompassing 590 cases and 691 reconstructed breasts. Eligible studies discussed breast reconstruction methods with at least three clinical cases, providing data on evolving techniques, complication rates, and outcomes. Searches in the PubMed database used comprehensive keywords targeting both implant-based and autologous methods.

resultsThe review found that implant-based approaches and early autologous techniques, such as the Transverse Rectus Myocutaneous and Latissimus Dorsi flaps, dominated the 1980s and 1990s. The 2000s introduced muscle-sparing options, such as the Deep Inferior Epigastric Perforator and Superficial Inferior Epigastric Artery flaps, reducing donor-site morbidity and enhancing recovery. In the 2010s, perforator flaps, including the Anterior Intercostal Artery and Profunda Artery Perforator flaps, expanded options for more personalized reconstructions. From 2020 to 2024, a resurgence of autologous techniques emphasized minimally invasive approaches to optimize recovery and patient well-being. Complication rates remained low, with seroma, infection, and fat necrosis as the most reported issues.

conclusionBreast reconstruction practices have evolved significantly, moving toward sophisticated autologous methods that improve aesthetics and minimize invasiveness. This patient-centered shift reflects modern surgical goals, enhancing both functional and psychological outcomes in breast cancer recovery. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .