Surgical management of breast carcinoma has evolved to include more breast conserving techniques such as skin-, nipple-, and areola-sparing mastectomies, as improved cosmesis becomes an increasing concern. However, the oncologic risk of these procedures must be strongly considered before such techniques can be widely adopted. Here we review available literature on these techniques and their associated clinical outcome. From our own experience, as well as from that reported, we conclude that nipple-, skin-, and areola-sparing mastectomies in carefully selected patients can have safe oncologic outcomes comparable to more traditional surgical techniques and therefore may be a feasible option for breast cancer management.

The following is a brief description of the reconstructive options available to patients undergoing mastectomy, and a review of the data available to guide clinicians who seek to safely integrate postmastectomy radiotherapy and breast reconstruction.

Radiation therapy is an important part of the modern multimodality treatment of breast cancer, and in the past decade has had an increasing role in the treatment of patients at intermediate to high risk for local-regional recurrence after mastectomy. During the same time period, a less radical surgical approach to mastectomy has developed that is more compatible with reconstruction, and a greater number of young patients diagnosed due to screening who are more motivated and candidates for the procedure. This has led to an increased need to consider the special implications of combining radiation with breast reconstruction. This review will focus on reconstruction by tissue expander and breast implants. A multidisciplinary approach to management is needed that includes a team of a plastic surgeon, and radiation, surgical and medical oncologists. Experience with implant reconstruction and radiation in the past decade has been associated with relatively high rates of complications and/or implant loss compared with unirradiated patients. However, newer techniques of radiation, and improved patient selection and coordination between the multidisciplinary team offer the promise of low complication rates and good or excellent cosmetic results for most patients in the future.