BREAST SURGERY
Breast Reconstruction
A Century of Controversies and Progress
Antoine Homsy, MD,* Eva Rüegg, MD,* Denys Montandon, MD,† Georges Vlastos, MD,‡1
Ali Modarressi, MD, PD,* and Brigitte Pittet, Pr*†
Abstract: Breast cancer treatment has dramatically changed over the past
century. Since Halsted’s first description of radical mastectomy in 1882,
breast reconstruction has evolved slowly from being considered as a use-
less or even dangerous procedure by surgeons to the possibility nowadays
of reconstructing almost any kind of defect. In this review on the develop-
ment of breast reconstruction, we outline the historical milestone innova-
tions that led to the current management of the mastectomy defect in an
attempt to understand the economic, social and psychological factors, which
contributed to slow down its acceptance for several decades.
Key Words: history, breast reconstruction, breast cancer
(Ann Plast Surg 2018;00: 00–00)
B reast amputation has been the standard treatment for breast cancer
for over a century, but breast reconstruction remained a subject of
controversy for several decades and was regarded as a useless or even
dangerous procedure by highly respected physicians. It is only during
the last 20 years that it began to be progressively accepted as an integral
part of breast cancer treatment. Today, different options are available
and breast reconstruction is now possible for almost every woman
in developed countries. In this paper, we review the evolution of
breast reconstruction following mastectomy from a historical per-
spective to understand why it has been a much-debated subject and
to identify the factors that slowed down its acceptance.
Halsted’s Heritage
William Stewart Halsted (1852–1922) described in 1882 the rad-
ical mastectomy for breast cancer.1 He proposed to remove the skin,
mammary gland, both pectoral muscles and axillary lymph nodes in
one block. The low recurrence rate obtained by Halsted’s technique ex-
plains the notoriety of his method. Interestingly, even if recurrence rates
were lower than other series during this period, controversies remained
regarding the survival rates of this so-called “lifesaving” intervention.2,3
Apart from medical reasons, politico-economic factors favoured Halsted’s
influence as the American Surgical Association was trying to establish
surgery as a specialty at that time. As hypothesized by Bland,2 Halsted
provided a perfect example to defend the specialisation of surgery
Received August 8, 2017, and accepted for publication, after revision October 24,
2017.
From the *Division of Plastic, Reconstructive and Aesthetic Surgery, Department of
Surgery, Geneva University Hospitals, University of Geneva Faculty of Medicine,
Geneva, Switzerland; †University of Geneva Faculty of Medicine, Geneva,
Switzerland; and ‡Department of Obstetrics and Gynaecology, Geneva University
Hospitals, Geneva, Switzerland.
1Deceased.
Conflicts of interest and sources of funding: none declared.
Funding source: No external funding source or sponsors were involved in the
preparation, writing and decision to submit this article.
Ethical approval was not required.
Reprints: Antoine Homsy, MD, Division of Plastic, Reconstructive and Aesthetic
Surgery, Department of Surgery, Geneva University Hospitals, 4 Rue Gabrielle-
Perret-Gentil, 1211 Geneva, Switzerland. E-mail: antoinehomsy@hotmail.com.
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0148-7043/18/0000–0000
DOI: 10.1097/SAP.0000000000001312
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
through his introduction of radical mastectomy. Bland highlighted also
“a nationalistic rivalry with medical leaders” in Europe favouring radi-
cal mastectomy and contributing to its success. Economic forces, but
also patriotism, made it difficult from thereon to criticise radical mas-
tectomy in the USA for several decades. It was only after the study of
Atkins et al. in the late 1970s that more conservative surgery began to
be accepted as an appropriate alternative in the USA.4
Halsted’s therapeutic approach had a negative influence on the
evolution of breast reconstruction. His technique left behind a huge
chest wall defect, a missing breast, a missing anterior axillary fold
and important scarring. Convinced that scar tissue was a barrier to the
local spread of cancer, he left the wound open and let it heal by second-
ary intention. In 1913, his position changed in favour of thin skin grafts
to cover the defect, mainly to reduce the common complications such
as infection, scar contractures, arm motion restrictions, and arm swell-
ing. He was convinced that: “when the defect is covered by a normal skin
or by reconstructive procedures, not only the underlying recurrence is
concealed for an indefinite period, but also the transferred skin with its
lymphatic channels brought from a distance, aids in the dissemination
of the disease”.5 For this reason, Halsted was against any type of recon-
struction. Furthermore, he believed that oncologic surgery might be
inadequately accomplished while anticipating reconstruction and he dis-
couraged the collaboration of general surgeons with plastic surgeons.
Halsted had an undeniable influence both in the USA and
Europe and created a context in which it became extremely difficult
to justify a reconstructive procedure. His profound belief was that
“attempts to hasten convalescence by such plastic operations as are
feasible only when a restricted amount of skin is removed, and may
sacrifice his patient to the disease”. He added: “as to the closure of
the wound, I should not care to say beware of the man with the plastic
operation”.6 Halsted’s convictions on reconstruction continued to dom-
inate the field and became established as the paradigm of breast cancer
treatment until the mid-1960s in Europe and even later in the USA.
Social Context and Psychological Aspects
Despite well-performed studies showing already in 1955 that
the psychological consequences of radical mastectomy were very often
devastating,7 Watson, a famous physician in the treatment of breast
cancer, wrote in 1966: “…psychological trauma… will usually have
been produced by the inquiry (of the physician) rather disclosed by
it. We are frequently amazed at the therapeutic passions aroused by
what is… an affliction of a superficial easily disposable utilitarian
appendage”.8 These comments well illustrate the very common denial
and presence of sexism in the medical world in the 1960s.9 Reconstruc-
tion was not a concern and women requesting it were considered to be
“narcissistic or immature”.10 Indeed, some women would not even ask
for fear of appearing ungrateful. This general social and medical con-
text dominated by sexism was an important obstacle to the development
of breast reconstruction. Not surprisingly, breast reconstruction was not
covered by medical insurances in most countries. For example, in
Switzerland, coverage of breast reconstruction for cancer by medical
insurance companies became mandatory only in 1984.11
www.annalsplasticsurgery.com 1
Homsy et al
Evolution of Breast Reconstruction Procedures
First Attempts
Czerny (1895)12 is credited to have been the first to replace the
breast volume with a lipoma. Verebely (1914) and then Bartlett (1917)
reported a series of autologous fat grafts as an “anatomic substitute of
the female breast”, stating that “the breast is of such a psychic impor-
tance to the female patient, that … it is the fear of having the breast
mutilated that keeps the patients away and allows a tumor to run a
progressive course. … Therefore, our problem is to re-establish breast
form, thus satisfying the psychic element…”.13
Breast reconstruction after total mastectomy requires skin sub-
stitution in addition to volume restoration. The first attempt was by
shifting a part of the other breast over the chest wall. Legueu (1898)14
and Morestin (1903),15 followed by others,16,17 published reports of this
method, which led to a single large unattractive mould in the middle of
the chest wall (Fig. 1). The procedure has been abandoned for onco-
logic reasons due to the frequency of bilateral cancers and the poor aes-
thetic results. Local skin flaps were initially used for skin coverage after
mastectomy at the end of the 19th century.18,19
Ombredanne (1906) used the pectoralis minor muscle after its
disinsertion from the coronoid process to create a rounded muscular
mass, which was covered by a rotating thoracoabdominal skin flap20,21
(Fig. 2). In 1906, Tansini designed the latissimus dorsi flap to cover the
chest wall defect (Fig. 3).22,23 It was reintroduced only in 1976 by
Olivari as a tool for breast reconstruction with an additional implant.24
The first attempts using autologous flaps had important shortcomings
and these long interventions left important scars with disappointing results.
Implant Reconstruction
The development of silicone implants by Cronin in 1963 was an
important step in breast reconstruction.25 Originally indicated for breast
augmentation, breast reconstruction after mastectomy was first attempted
with a subcutaneous silicone implant in 1971.26 High complication
rates and unsatisfactory aesthetic results led to the development of the
submuscular implant technique in 1978,27 as well as the introduction
of the tissue expander.28 Thus, breast implants evolved to make breast
reconstruction a shorter and less invasive procedure without additional
scars. These aspects helped breast reconstruction to gain popularity and
acceptance among the population and general surgeons and even
renewed the interest in autologous techniques. However, in comparison
to autologous tissue, implant-based reconstruction presents several dis-
advantages: higher surgical site infection rate, unnatural texture, capsu-
lar contracture, and a risk of implant rupture. Re-operation rates have
been reported to be as high as 30%,29 particularly after radiotherapy.
Autologous Reconstruction
The rediscovery of the musculocutaneous unit and cutaneous
vascular territories, associated with the advent of microsurgery, has
launched an impressive era of progress for autologous reconstruction
over the last 30 years.30 It has several advantages compared to implants.
First, in addition to volume restoration, it can reconstruct a skin defect,
thus making virtually all types of defect amenable to reconstruction.
The obvious advantage is the absence of a foreign body with a long-
lasting result that looks and feels more natural. However, the interven-
tion is usually longer and technically more demanding, especially in
the case of free flaps. Disadvantages include donor site morbidity, but
these are less important with the evolution of perforator flaps. Depend-
ing on the defect, autologous breast reconstruction options are a pedi-
cled latissimus dorsi flap with an implant or an extended latissimus
dorsi flap without implant, abdomen-based flaps (e.g. deep inferior epi-
gastric artery perforator [DIEP]), or gluteal and thigh-based flaps.
2 www.annalsplasticsurgery.com
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018
FIGURE 1. Result of breast-sharing technique from H. Morestin,
1903. Reproduced from Ref.15
Latissimus Dorsi Pedicled Flap (LD)
Tansini’s flap is recognised as the first myocutaneous flap
(Fig. 3), but in the context of Halsted’s principle “not to use a flap”, it
was forgotten for 70 years.31 Reintroduced in 1976 by Olivari,24 the flap
includes the LD muscle, a skin island and more or less subcutaneous
tissue. It is a rapidly accessible and reliable manner to transfer autolo-
gous tissue as no microvascular anastomosis is necessary. Further
developments32–36 led to its standardisation and wide use in one-stage
breast reconstructions with implants in the 1980s. The extended LD
developed by Hokin (1983) includes the whole muscle and a large skin
flap.36 Its folding allows the projection and formation of a breast
mound, thus avoiding the use of prosthesis. However, its main disad-
vantages are the scar at the donor site and its limited volume.
Abdomen-Based Flaps
There are many advantages using the abdomen as a donor site.
The skin colour and type matches with the breast. Moreover the typical
abdominal fat deposit provides sufficient volume for breast mound
reconstruction without an implant in many cases, while leaving the
abdomen with a result comparable to an abdominoplasty.
In 1974, Tai and Hasegawa introduced the medially based trans-
verse abdominal skin flap by preserving the perforating vessels from the
superior epigastric artery and vein on the rectus abdominis to improve
viability.37 These observations were the results of intense research for
independent cutaneous vascular territories and preceded the rediscovery
of myocutaneous flaps.30,38–40 Hartrampf41 showed that a large trans-
verse abdominal myocutaneous (TRAM) island flap crossing the mid-
line could be sustained by only one superior epigastric artery through
one rectus muscle, allowing reconstruction of large chest wall defects
without implant. At that time, the pedicled TRAM flap became the most
widely used technique for autologous breast reconstruction. The main
complications were anterior wall hernia and partial necrosis of the flap.
In 1984, Boyd et al.42 showed that the inferior profound epigastric artery
was the main artery of the rectus abdominis, explaining the high rate
of necrosis.
With the advent of microvascular tissue transfer, free flaps have
been developed to improve vascularisation.43 Holmstrom was the first
to use a free TRAM flap for breast reconstruction in 1979.44 This
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018 Breast Reconstruction History

FIGURE 2. Portrait of Louis Obredanne (1871–1956) (A) and drawings (B) reproduced from Ref.20

technique slowly replaced the pedicled flap as microvascular surgery
techniques improved. It lowered the risk of partial necrosis being based
on the inferior profound epigastric artery. Afterwards to reduce the do-
nor site morbidity, the muscle-sparing and even extreme-muscle sparing
free TRAM was developed where the amount of muscle harvested was
decreased.45 The progress from musculocutaneous flaps to muscle-
sparing flaps led to the advent of fascio-cutaneous flaps relying on per-
forator arteries. The deep inferior epigastric perforator (DIEP) flap was
first described in 198946 and introduced in breast reconstruction in
1994 by Allen.47 This technique requires only a rectus muscle fascia in-
cision and dissection of the vascular pedicle without muscle harvest.
Even if the DIEP flap is actually considered as the gold standard for au-
tologous breast reconstruction, it is more challenging and requires a
longer learning curve in comparison to free TRAM flaps. The superfi-
cial inferior epigastric artery (SIEA) flap, based on a subcutaneous vas-
cular pedicle, was described for the first time in 1991 and allows
transferring the same lower abdominal flap as a DIEP without incising
the fascia.48 Although it preserves completely abdominal muscle wall,
SIEA is rarely indicated due to anatomical variety of its vascular pedicle
and the small vessel diameter that may increase the risk of flap failure.49
Gluteal and Upper Thigh-Based Flaps
Fujino et al. first reported on breast reconstruction using a but-
tock free flap in 1975,50 by introducing the superior gluteal artery
(SGA) free flap. The inferior gluteal artery (IGA) free flap was then
introduced in 1988.51 The evolution of techniques led to the introduc-
tion of the SGA and IGA perforator flaps in 1995 and 2002, respec-
tively.52 The SGA flap has a more reliable pedicle than the IGA and
the donor site has the advantage of a better cosmetic outcome.
The musculocutaneous gracilis flap was introduced in 1976 for
the coverage of different soft tissue defects.53 The skin paddle was then
designed vertically, overlying the muscle. In 1993, Yousif et al. designed
the transverse myocutaneous gracilis flap (TMG).54 Since then, the reli-
ability of the flap has been well demonstrated and it became a popular
alternative for breast reconstruction.55–57 Allen recently introduced
the profunda artery perforator flap (PAP)58 to provide a large and well
vascularized flap without muscle harvest. However, it requires more
meticulous muscle dissection.59
Gluteal and thigh based flaps are an alternative when abdominal
flaps are not indicated.
The lateral upper thigh is also a source of a possible donor
site. The tensor fasciae latae myocutaneous free flap was first used
for breast reconstruction in 199060 and introduced as a perforator
flap in 2011.61 It has recently emerged as a possible alternative for
breast reconstruction compared to the SGA perforator flap.62 The re-
ported advantages are the longer pedicle and avoiding changing from a
prone to supine position, with a comparable volume. However, limita-
tions include wound dehiscence at the donor site if the skin paddle is

FIGURE 3. Portrait of Iginio Tansini (1855–1943), Reproduced from Ref.31 The latissimus dorsi myocutaneous flap.

© 2018 Wolters Kluwer Health, Inc. All rights reserved. www.annalsplasticsurgery.com 3

Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Homsy et al
TABLE 1. Historical Summary of Breast Cancer Management and Reconstruction Milestones (1590–2012)
Breast Cancer Management
7
1590—Cabrol—Removal of Pectoralis Major
1992—Cosendey—Lymph nodes ablation63
1847—Introduction of general anaesthesia with chloroform
1865—Lister—surgical instrument sterilization
1890—Koch—germs causing infection
18
1893—Shrady—Sliding skinflaps
1
1894—Halsted—Radical mastectomy
1913—Halsted—position changed in favour of thin skin grafts to
cover the defect5
13
1917—Bartlett—Defends tumorectomy and histologic evaluation
1928—Keynes—radium radiation therapy associated to tumour resection66
1940—Wangensteen—additional excision of mediastinal, internal
mammary and supraclavicular lymph nodes68
1948—Patey—modified radical mastectomy70
1952—Urban—additional excision of chest wall71
1952—Renneker and Cutler—the double hit theory73
1976—Bonadonna—Introduction of chemotherapy77
1982—Shapiro—Mammography population screening beneficial83
4 www.annalsplasticsurgery.com
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018
Breast Reconstruction
1893—Czerny—First breast reconstruction12
1898—Legueu—Contralateral breast flap14
1906—Ombredanne—Pectoralis minor muscle flap and thoracoabdominal
cutaneous flap20
1906—Tansini—latissimus dorsi myocutaneus flap22,23
1916—Filatoff—tubed pedicle flap64
1917—Bartlett—Fat grafts13
1919—Bruning—first autologous injected fat graft65
1937—Webster—introduces the thoraco-epigastric tubed pedicle67
1942—Gillies—tubed flank flap69
1952—Marino—Dermal-Fat composite grafts72
1953—Bames—lipo-dermo-fascial graft74
1963—Kiricuta—pedicled flap of the greater omentum75
1971—Snyderman and Guthrie—Subcutaneous implants26
1972—McLean and Buncke—first clinical free flap transfer43
1973—Orticochea—gluteal flap, multiple transfers76
1974—Tai and Hasegawa—transverse abdominal skin flap37
1975—Fujino et al.—SGA free flap50
1976—Millard78—abdominal tubed flap
1976—Olivari—reintroduces the Latissimus Dorsi Flap24
1976—Harii et al.—musculocuatneous Gracilis flap53
1977—Drever—Vertical Rectus Abdominis Myocutaneous (VRAM) flap79
1978—Jarrett et al.—submuscular implant27
1978—Radovan—introduced the tissue expander28
1978—John Bostwick—one-stage reconstructions on large series32
1979—Robbins—VRAM flap80
1979—Holmstrom free TRAM flap44
1980—Le-Quang—inferior gluteal artery (IGA) free flap81
1981—Marino and Dogliotti—bipedicled version of the
epigastric myocutaneous flap82
1982—Hartrampf et al.—TRAM Flap41
1983—Hokin—Extended Latissimus Dorsi flap36
1986—Coleman—standardized the technique of structural fat grafting84,85
1988—Paletta, Bostwick and Nahai—IGA free flap51
1989—Koshima and Soeda—Introduction of DIEP46
1990—Elliott—Lateral transverse thigh free flap60
1991—Grotting—SIEA Flap48
1992—Yousif et al.—transverse musculacutaneous gracilis flap54
1993—Koshima et al.—SGA perforator flap (SGAP)52
1994—Allen and Treece—DIEP Flap47
Continued next page
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018
TABLE 1. (Continued)
Breast Cancer Management
87
1997—Veronesi—Sentinel lymph node biopsy
too large and a lateral scar sometimes demanding a balancing procedure
in unilateral cases.
DISCUSSION
Since the introduction of the radical mastectomy by Halsted,
women had to wait almost a century before being offered the opportu-
nity of a satisfactory breast reconstruction. The dogmas, the psycholog-
ical context, and the surgical limits have played an undeniable part in
the difficulty for breast reconstruction to be recognised as an integral
part of the treatment for breast cancer (Table 1). The historical med-
ical context is important to keep in mind in order to better understand
this evolution. Moreover, the tremendous development of oncological
understanding in tumour biology, radiological improvements in diagnos-
tics, and the findings of systemic treatments have permitted an evolu-
tion towards a more conservative surgery.63
In parallel to the ultra-aggressive treatment defended by the
Halstedian school of thought, Europeans proposed a more conservative
surgical approach. Already in the 1950s, Patey challenged Halsted’s
view by preserving the pectoralis major, while offering a comparable
FIGURE 4. Mastectomies and breast reconstructions from 1993 to 2015 at our institution. Effect of the introduction of a preoperative
multidisciplinary consultation for breast cancer patients in 2000 and of dedicated supplementary OR vacancy. University of Geneva
Hospitals, Geneva, Switzerland.
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Breast Reconstruction History
Breast Reconstruction
1995—Allen and Tucker—SGAP86
2001—Cothier-Savey et al.—laparoscopically harvested omental
flap (LHOF)88
2002—Peek et al.—Gracilis perforator flap89
2002—Higgins and Blondeel—IGA perforator (IGAP)90
2004—Guerra et al—IGAP91
2011—Kind—lateral femoral circumflex artery perforator flap61
2012—Allen—PAP Flap58
local recurrence and survival rates.70 Patey’s technique gained rapid
acceptance in Europe, but had few supporters in the USA. One of these
was Madden, who introduced the “modified” radical mastectomy in
1965,92 also preserving the pectoralis minor.
Radiologic developments in diagnosis and treatment had also a
major influence on the surgical management of breast tumours. In the
1970s, the diagnosis of cancer by mammography was popularised.83
The earlier diagnosis of cancer lowered the proportion of women
undergoing radical mastectomy. As early as 1928, Keynes66 defended
radium radiation therapy associated with tumour resection as an alter-
native to a radical procedure. In the 1950s, several studies showed that
conservative surgery with radiotherapy had the same survival rates as
radical surgery.93–95
Regarding systemic treatments, Gianni Bonadonna77 presented in
1976 the first reports on the efficiency of a chemotherapy combination
(cyclophosphamide, methotrexate and fluorouracil) as an adjuvant treat-
ment for breast cancer. These treatments, when performed before the
surgery, allow increasing indications for less mutilating surgical ap-
proaches such as modified or skin-sparing mastectomy, and nowadays
www.annalsplasticsurgery.com 5
Homsy et al
even nipple-sparing mastectomy. These more conservative oncologic re-
sections permitting better aesthetic results, thanks to the preservation
of the skin envelope of the breast.
The multiple operations often needed for the breast mound
reconstruction have been an important drawback until the end of the
1970s when surgeons finally proved the feasibility of one-stage recon-
structions in large series.32
Together with the progress of surgical techniques, such as micro-
surgery, the rediscovery of anatomical myocutaneous units in the 1980s
and of cutaneous vascular territories have allowed the development of
an important variety of flaps and new reconstruction options. In parallel,
the progress of anaesthesia has also allowed to perform these longer and
challenging interventions in a safe manner.
Finally, collaboration between oncologists, gynaecologists, and
plastic surgeons is mandatory for patient access to breast reconstruc-
tion. At present, the necessity of a preoperative multidisciplinary con-
sultation for breast cancer patients is included in guidelines for breast
centres. During this consultation, all cases of breast cancer are presented
and discussed before any therapeutic intervention. Patients who are can-
didates for breast reconstruction are informed individually regarding
reconstruction technical options and timing. Since the introduction of
this consultation in 2000 in our institution, we have observed a dramatic
increase in the number of patients requesting breast reconstruction and
benefiting from immediate and autologous reconstructions (Fig. 4).96
As immediate breast reconstruction offers a higher satisfaction
rate and better aesthetic results compared to secondary reconstruction,
it should be privileged and made possible for all eligible patients.97,98
Currently, autologous breast reconstruction is considered as the gold
standard, particularly using the DIEP flap. The vascular supply is reli-
able and the resultant scar is respects the abdominal aesthetic unit and
has the advantage of an abdominoplasty at the donor site. A recent
meta-analysis suggests a decreased risk of surgical site infection and
reconstructive failure compared to implant-based reconstruction,
despite the technical difficulty of the procedure.99 Importantly, patients
appreciate the natural feeling and longevity of results obtained by
autologous reconstruction.
CONCLUSION
Innovation in surgery is dependent not only on technical and
scientific progress, but it is also strongly linked with the psychosocial
evolution of society and the medical actors. Breast reconstruction is
not an exception. It has relied on the development of scientific knowl-
edge and slowed down by dogmas. However, it is justified by acknowl-
edging the trauma caused by breast amputation. Achieving satisfying
aesthetic results in a reliable and reproducible manner is the sine qua non
to promote breast reconstruction. Recent history emphasises also the
necessity for breast centres, allowing better communication and collab-
oration for optimal patient management.
REFERENCES
1. Halsted WS. I. The results of operations for the cure of cancer of the breast
performed at the Johns Hopkins Hospital from June, 1889, to January, 1894.
Ann Surg. 1894;20:497–555.
2. Bland CS. The Halsted mastectomy: present illness and past history. West J Med.
1981;134:549–555. Epub 1981/06/01.
3. Halsted WS. I. A clinical and histological study of certain adenocarcinomata of
the breast: and a brief consideration of the supraclavicular operation and of
the results of operations for cancer of the breast from 1889 to 1898 at the Johns
Hopkins Hospital. Annals of surgery. 1898;28:557–576. Epub 1898/11/01.
4. Atkins H, Hayward JL, Klugman DJ, et al. Treatment of early breast cancer:
a report after ten years of a clinical trial. Br Med J. 1972;2:423–429. Epub
1972/05/20.
5. WS Halsted MD. Developments in the skin-grafting operation for cancer of the
breast. JAMA. 1913;60:416–418.
6. Hasted WS. I. The results of radical operations for the cure of carcinoma of the
breast. Ann Surg. 1907;46:1–19.
6 www.annalsplasticsurgery.com
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018
7. Bard M, Sutherland AM. Psychological impact of cancer and its treatment. IV.
Adaptation to radical mastectomy. Cancer. 1955;8:656–672. Epub 1955/07/01.
8. Watson TA. Cancer of the breast. The Janeway Lecture—1965. Am J Roentgenol
Radium Ther Nucl Med. 1966;96:547–559. Epub 1966/03/01.
9. Maguire P. The psychological and social consequences of breast cancer. Nurs
Mirror Midwives J. 1975;140:54–57. Epub 1975/04/03.
10. Elliott LF, Hartrampf CR Jr. Breast reconstruction: progress in the past decade.
World J Surg. 1990;14:763–775. Epub 1990/11/01.
11. l'assurance-maladie. Cfdpgd. Avis du 23 août 1984. RAMA. 1984:212, ch.3.
12. Goldwyn RM. Vincenz Czerny and the beginnings of breast reconstruction.
Plast Reconstr Surg. 1978;61:673–681. Epub 1978/05/01.
13. Bartlett W. An anatomic substitute for the female breast. Ann Surg. 1917;66:
208–211. Epub 1917/08/01.
14. Legueu MF. De l’autoplastie par glissement du sein. Congrès français de
chirurgie. 1898;12:225–227.
15. Morestin H. De l‘autoplastie par déplacement de sein. Archives Générales de
médecine. 1903;2:2689–2698.
16. Harris HI. Automammaplasty. J Int Coll Surg. 1949;12:827–839. illust. Epub
1949/11/01.
17. Pontes R. Single stage reconstruction of the missing breast. Br J Plast Surg. 1973;
26:377–380. Epub 1973/10/01.
18. Shrady GF. A simple method of closing large operation wounds by sliding skin-
flaps. Med Rec. 1893;44:717.
19. Elsberg CA. The abdominal skin-flap in radical amputation of the breast.
Ann Surg. 1915;62:678–678.2. Epub 1915/12/01.
20. Ombredanne L. Restauration autoplastique du sein après amputation totale.
Trb Med. 1906;4:325.
21. Teimourian B, Adham MN. Louis Ombredanne and the origin of muscle flap
use for immediate breast mound reconstruction. Plast Reconstr Surg. 1983;72:
905–910. Epub 1983/12/01.
22. Tansini I. Sopra il mio nuovo processo di amputazione della mammella. Riforma
Med. 1906;12:757–759.
23. Tansini I. Nuovo processo per l’amputazione della mammaella per cancre.
Riforma Med. 1896;12:3.
24. Olivari N. The latissimus flap. Br J Plast Surg. 1976;29:126–128. Epub 1976/04/01.
25. Glicenstein J. [History of augmentation mammaplasty]. Annales de chirurgie
plastique et esthetique. 2005;50:337–349. Epub 2005/09/28. Histoire de l'aug-
mentation mammaire.
26. Snyderman RK, Guthrie RH. Reconstruction of the female breast following radi-
cal mastectomy. Plast Reconstr Surg. 1971;47:565–567. Epub 1971/06/01.
27. Jarrett JR, Cutler RG, Teal DF. Subcutaneous mastectomy in small, large, or ptotic
breasts with immediate submuscular placement of implants. Plast Reconstr Surg.
1978;62:702–705. Epub 1978/11/01.
28. Radovan C. Breast reconstruction after mastectomy using the temporary expander.
Plast Reconstr Surg. 1982;69:195–208. Epub 1982/02/01.
29. Zhong T, McCarthy CM, Price AN, et al. Evidence-based medicine: breast recon-
struction. Plast Reconstr Surg. 2013;132:1658–1669. Epub 2013/11/28.
30. McCraw JB. The recent history of myocutaneous flaps. Clin Plast Surg. 1980;7:
3–7. Epub 1980/01/01.
31. Maxwell GP. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous
flap. Plast Reconstr Surg. 1980;65:686–692. Epub 1980/05/01.
32. Bostwick J 3rd, Vasconez LO, Jurkiewicz MJ. Breast reconstruction after a radical
mastectomy. Plast Reconstr Surg. 1978;61:682–693. Epub 1978/05/01.
33. McShane RH, Omotunde O, Weatherly-White RC. Individualized muscle cover-
age of implants in breast reconstruction. Plast Reconstr Surg. 1981;67:318–327.
Epub 1981/03/01.
34. Wolf LE, Biggs TM. Aesthetic refinements in the use of the latissimus dorsi flap in
breast reconstruction. Plast Reconstr Surg. 1982;69:788–793. Epub 1982/05/01.
35. McCraw JB, Papp C, Edwards A, et al. The autogenous latissimus breast recon-
struction. Clin Plast Surg. 1994;21:279–288. Epub 1994/04/01.
36. Hokin JA. Mastectomy reconstruction without a prosthetic implant. Plast Reconstr
Surg. 1983;72:810–818. Epub 1983/12/01.
37. Tai Y, Hasegawa H. A transverse abdominal flap for reconstruction after radical
operations for recurrent breast cancer. Plast Reconstr Surg. 1974;53:52–54. Epub
1974/01/01.
38. McGregor IA, Jackson IT. The groin flap. Br J Plast Surg. 1972;25:3–16. Epub
1972/01/01.
39. V.Y. Bkamjian NKC, Bades HW. Versatility of the deltopectoral flap in reconstruc-
tion following head and neck cancer surgery. In: Trans Fourth Internat Cong Plast
Reconstr Surg. Amsterdam: Excerpta Medica; 1967:808.
40. Brown RG, Vasconez LO, Jurkiewicz MJ. Transverse abdominal flaps and the
deep epigastric arcade. Plast Reconstr Surg. 1975;55:416–421. Epub 1975/04/01.
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Annals of Plastic Surgery • Volume 00, Number 00, Month 2018
41. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse
abdominal island flap. Plast Reconstr Surg. 1982;69:216–225. Epub 1982/02/01.
42. Boyd JB, Taylor GI, Corlett R. The vascular territories of the superior epigas-
tric and the deep inferior epigastric systems. Plast Reconstr Surg. 1984;73:1–16.
Epub 1984/01/01.
43. McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect,
with microsurgical revascularization. Plast Reconstr Surg. 1972;49:268–274.
Epub 1972/03/01.
44. Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction.
An experimental study and clinical case report. Scand J Plast Reconstr Surg.
1979;13:423–427. Epub 1979/01/01.
45. Chang DW. Breast reconstruction with microvascular MS-TRAM and DIEP flaps.
Arch Plast Surg. 2012;39:3–10. Epub 2012/07/12.
46. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis
muscle. Br J Plast Surg. 1989;42:645–648. Epub 1989/11/01.
47. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruc-
tion. Ann Plast Surg. 1994;32:32–38. Epub 1994/01/01.
48. Grotting JC. The free abdominoplasty flap for immediate breast reconstruction.
Ann Plast Surg. 1991;27:351–354. Epub 1991/10/01.
49. Chevray PM. Update on breast reconstruction using free TRAM, DIEP, and SIEA
flaps. Seminars in plastic surgery. 2004;18:97–104. Epub 2004/05/01.
50. Fujino T, Harasina T, Aoyagi F. Reconstruction for aplasia of the breast and
pectoral region by microvascular transfer of a free flap from the buttock. Plast
Reconstr Surg. 1975;56:178–181. Epub 1975/08/01.
51. Paletta CE, Bostwick J 3rd, Nahai F. The inferior gluteal free flap in breast reconstruc-
tion. Plast Reconstr Surg. 1989;84:875–883. discussion 84–5. Epub 1989/12/01.
52. Koshima I, Moriguchi T, Soeda S, et al. The gluteal perforator-based flap for repair
of sacral pressure sores. Plast Reconstr Surg. 1993;91:678–683. Epub 1993/04/01.
53. Harii K, Ohmori K, Sekiguchi J. The free musculocutaneous flap. Plast Reconstr
Surg. 1976;57:294–303. Epub 1976/03/01.
54. Yousif NJ, Matloub HS, Kolachalam R, et al. The transverse gracilis musculo-
cutaneous flap. Ann Plast Surg. 1992;29:482–490. Epub 1992/12/01.
55. Bodin F, Schohn T, Lutz JC, et al. [The transverse musculocutaneous gracilis free
flap: innovative autologous breast reconstruction]. Ann Chir Plast Esthet. 2013;
58:18–27. Epub 2012/06/29. Le lambeau de gracilis a palette transversale: une
nouvelle technique de reconstruction mammaire autologue.
56. Wechselberger G, Schoeller T, Bauer T, et al. Surgical technique and clinical appli-
cation of the transverse gracilismyocutaneous free flap. Br J Plast Surg. 2001;54:
423–427. Epub 2001/06/29.
57. Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a
valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg.
2004;114:69–73. Epub 2004/06/29.
58. Allen RJ, Haddock NT, Ahn CY, et al. Breast reconstruction with the profunda
artery perforator flap. Plast Reconstr Surg. 2012;129:16e–23e.
59. Hunter JE, Lardi AM, Dower DR, et al. Evolution from the TUG to PAP flap for
breast reconstruction: comparison and refinements of technique. J Plast Reconstr
Aesthet Surg. 2015;68:960–965.
60. Elliott LF, Beegle PH, Hartrampf CR Jr. The lateral transverse thigh free flap: an
alternative for autogenous-tissue breast reconstruction. Plast Reconstr Surg. 1990;
85:169–178. discussion 79–81. Epub 1990/02/01.
61. Kind GM, Foster RD. Breast reconstruction using the lateral femoral circumflex
artery perforator flap. J Reconstr Microsurg. 2011;27:427–432. Epub 2011/07/19.
62. Tuinder S, Baetens T, De Haan MW, et al. Septocutaneous tensor fasciae latae per-
forator flap for breast reconstruction: radiological considerations and clinical
cases. J Plast Reconstr Aesthet Surg. 2014;67:1248–1256. Epub 2014/06/11.
63. Cosendey BA. [History of breast cancer treatment]. Revue Méd Suisse Rom. 1992;
112:179–184.
64. Filatoff VP. Plastic procedure using a round pedicle. Vestnik Oftolmolgii. 1917;34:
149–159.
65. Bruning P. Contribution a l’etude def greffes adipeuses. Bull Acad R Med
Belgique. 1919;28:440.
66. Keynes G. The radium treatment of primary carcinoma of the breast. Can Med
Assoc J. 1934;30:24–30. Epub 1934/01/01.
67. Webster JP. Thoraco-epigastric tubed pedicles. Surg Clin North Am. 1937;17:145–184.
68. Wangensteen O. Remarks on extension of the Halsted operation for cancer of the
breast. Ann Surg. 1949;13:315.
69. Gillies H. Surgical replacement of the breast. Proc R Soc Med. 1959;52:597–602.
Epub 1959/08/01.
70. Patey DH, Dyson WH. The prognosis of carcinoma of the breast in relation to the
type of operation performed. Br J Cancer. 1948;2:7–13.
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Breast Reconstruction History
71. Urban JA. Radical excision of the chest wall for mammary cancer. Cancer. 1951;
4:1263–1285. Epub 1951/11/01.
72. Marino H. Glandular mastectomy: immediate reconstruction. Plast Reconstr Surg
(1946). 1952;10:204–208. Epub 1952/09/01.
73. Renneker R, Cutler M. Psychological problems of adjustment to cancer of the
breast. JAMA. 1952;148:833–838. Epub 1952/03/08.
74. Bames HO. Augmentation mammaplasty by lipo-transplant. Plast Reconstr Surg
(1946). 1953;11:404–412. Epub 1953/05/01.
75. Kiricuta I. [The use of the great omentum in the surgery of breast cancer]. Presse
Med. 1963;71:15–17. Epub 1963/01/05.
76. Orticochea M. Use of the buttock to reconstruct the breast. Br J Plast Surg. 1973;
26:304–309. Epub 1973/07/01.
77. Bonadonna G, Brusamolino E, Valagussa P, et al. Combination chemotherapy
as an adjuvant treatment in operable breast cancer. N Engl J Med. 1976;294:
405–410. Epub 1976/02/19.
78. Millard DR Jr. Breast reconstruction after a radical mastectomy. Plast Reconstr
Surg. 1976;58:283–291. Epub 1976/09/01.
79. Drever JM. The epigastric island flap. Plast Reconstr Surg. 1977;59:343–346.
Epub 1977/03/01.
80. Robbins TH. Rectus abdominis myocutaneous flap for breast reconstruction.
Aust N Z J Surg. 1979;49:527–530. Epub 1979/10/01.
81. Le-Quang C. Two new free flaps developed from aesthetic surgery II. The inferior
gluteal flap. Aesthetic Plast Surg. 1980;4:159–168.
82. Marino H Jr, Dogliotti P. Mammary reconstruction with bipedicled abdominal
flap. Plast Reconstr Surg. 1981;68:933–936. Epub 1981/12/01.
83. Shapiro S, Venet W, Strax P, et al. Ten- to fourteen-year effect of screening on
breast cancer mortality. J Natl Cancer Inst. 1982;69:349–355. Epub 1982/08/01.
84. Coleman WP 3rd. Autologous fat transplantation. Plast Reconstr Surg. 1991;88:
736. Epub 1991/10/01.
85. Coleman SR. Long-term survival of fat transplants: controlled demonstrations.
Aesthetic Plast Surg. 1995;19:421–425. Epub 1995/09/01.
86. Allen RJ, Tucker C Jr. Superior gluteal artery perforator free flap for breast recon-
struction. Plast Reconstr Surg. 1995;95:1207–1212. Epub 1995/06/01.
87. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary
dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;
349:1864–1867. Epub 1997/06/28.
88. Cothier-Savey I, Tamtawi B, Dohnt F, et al. Immediate breast reconstruction
using a laparoscopically harvested omental flap. Plast Reconstr Surg. 2001;
107:1156–1163; discussion 64–5. Epub 2001/05/25.
89. Peek A, Müller M, Exner K. The free gracilis perforator flap for autologous breast
reconstruction. Handchir Mikrochir Plast Chir. 2002;34:245–250.
90. Higgins JP, Orlando GS, Blondeel PN. Ischial pressure sore reconstruction using
an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg. 2002;55:83–85.
Epub 2002/01/11.
91. Guerra AB, Metzinger SE, Bidros RS, et al. Breast reconstruction with gluteal
artery perforator (GAP) flaps: a critical analysis of 142 cases. Ann Plast Surg.
2004;52:118–125. Epub 2004/01/28.
92. Madden JL. Modified radical mastectomy. Surg Gynecol Obstet. 1965;121:
1221–1230. Epub 1965/12/01.
93. Mc WR. The value of simple mastectomy and radiotherapy in the treatment of
cancer of the breast. Br J Radiol. 1948;21:599–610. Epub 1948/12/01.
94. Williams IG, Murley RS, Curwen MP. Carcinoma of the female breast: conserva-
tive and radical surgery. Br Med J. 1953;2:787–796. Epub 1953/10/10.
95. Kaae S, Johansen H. Breast cancer; five year results: two random series of simple
mastectomy with postoperative irradiation versus extended radical mastectomy.
Am J Roentgenol Radium Ther Nucl Med. 1962;87:82–88. Epub 1962/01/01.
96. Thomet C, Modarressi A, Rüegg E, et al. Impact d’une consultation multi-
disciplinaire pré-thérapeutique dans la prise en charge du cancer du sein.
Swiss Med Forum. 2014:3–5.
97. Nano MT, Gill PG, Kollias J, et al. Psychological impact and cosmetic outcome of
surgical breast cancer strategies. ANZ J Surg. 2005;75:940–947. Epub 2005/12/13.
98. Georgiade GS, Riefkohl R, Cox E, et al. Long-term clinical outcome of immedi-
ate reconstruction after mastectomy. Plast Reconstr Surg. 1985;76:415–420.
Epub 1985/09/01.
99. Tsoi B, Ziolkowski NI, Thoma A, et al. Safety of tissue expander/implant versus
autologous abdominal tissue breast reconstruction in postmastectomy breast
cancer patients: a systematic review and meta-analysis. Plast Reconstr Surg.
2014;133:234–249. Epub 2014/01/29.
www.annalsplasticsurgery.com 7