On May 14, 2013, the famous Hollywood actress Angelina Jolie publicly admitted in an article published in the New York Times that she had undergone a bilateral prophylactic mastectomy to reduce her risk of breast cancer. Careful viewers noticed that Angelina’s figure did not change too significantly after undergoing breast cancer surgery. It turns out that as early as February 2013, when Jolie underwent a mastectomy for breast cancer, she began the process of breast reconstruction until the end of April, when the reconstruction was a complete success. With the rapid socio-economic development of our country, the categories of tumors that the population is susceptible to have have changed significantly. The incidence of breast cancer is rapidly increasing and has been the most common malignant tumor among adult women in China for several years, and the incidence of breast cancer is showing a trend of low age. According to incomplete statistics, the number of breast cancer cases in Zhejiang Province reached 2171 in 2012. Breast is an important secondary sexual characteristic and aesthetic organ of women. The obvious breast deformity left after mastectomy is a very heavy blow to patients’ self-confidence and greatly reduces their quality of life. In the past, breast cancer treatment was mainly aimed at complete removal of tumor, prevention of recurrence and improvement of tumor-free survival rate of patients, with less attention to post-operative appearance and psychological changes of patients. With the advancement of early diagnosis technology and surgery and radiotherapy for breast cancer, the 5-year survival rate of breast cancer patients has increased dramatically. In China, the 5-year survival rate after breast cancer surgery is close to 87%, which is basically close to the international advanced level. Some scholars even believe that breast cancer is no longer a “systemic disease”. After solving the survival problem of breast cancer patients, how to improve their post-operative appearance and reconstruct a satisfactory and symmetrical breast is on the agenda. After decades of development, breast reconstruction technology in developed countries has now reached a high level. It is no exaggeration to say that the appearance of most reconstructed breasts can be almost faked, except for the postoperative incision scar. The proportion of breast reconstruction after breast cancer surgery in the United States has exceeded 50%, and in Japan it has reached more than 25%, and all of them are covered by national health insurance. In contrast, breast reconstruction in China has been carried out at a later stage and the level varies. Due to the lack of exact statistical data, it is estimated that the rate of reconstructive surgery after breast cancer in China is less than 5%. The concept of most domestic breast reconstructive surgeons still remains at the level of “flap transfer, repairing trauma”, and the reconstructed breast lacks three-dimensional appearance and aesthetics, which is hardly satisfactory. In terms of the current situation, the most urgent task of breast reconstruction surgery in China is to establish a standard procedure and treatment specification that meets the characteristics of Chinese women, and to establish professional admission standards and assessment system for breast reconstruction surgery. At present, the popularization and improvement of this technology are both important, but the popularization should be the main focus. According to the different timing of reconstructive surgery, breast reconstructive surgery can be divided into two types: one-stage reconstructive surgery and late-stage reconstructive surgery. Generally speaking, because of the freshness of the trauma, the absence of old scars, and the clear and intact borders of the breast skin and soft tissues, the surgical results of the first-stage reconstruction are better than those of the later stage reconstruction. Patients can complete the treatment of breast cancer and breast reconstruction in one surgery, which reduces hospitalization time and medical costs; moreover, patients can get a fair-looking breast after waking up from general anesthesia, which has less psychological impact on patients. However, due to the unsatisfactory medical environment in China, patients with stage I reconstruction generally have high expectations of the post-operative reconstructive results because they have not experienced the process of severe breast deformity after mastectomy, which may lead to unnecessary conflicts. Patients with post-stage reconstruction may have certain adverse effects on the results of breast reconstruction because of traumatic scarring and post-operative radiotherapy. At present, stage I reconstruction is the mainstream internationally, and the proportion of stage I reconstruction and late reconstruction is roughly equal in China. There are more methods available for breast reconstruction, which can be broadly divided into two categories: breast reconstruction based on implantation and breast reconstruction based on autologous tissue transplantation. If a patient undergoes breast-conserving surgery or modified radical treatment with the pectoralis major muscle intact and not much skin or soft tissue removed, breast reconstruction with implants can be considered. Since the lower part of the prosthesis is not covered by the pectoralis major muscle, a biomaterial patch or allogeneic dermal repair can be used to avoid the lower part of the prosthesis being located directly under the skin and the sense of contour of the prosthesis being obvious after surgery. If the patient has more skin and soft tissue removed but less than 7 cm compared to the normal side, implantation of expanders may be considered first. Skin expansion is performed for about 3 to 6 months, and then the expander is removed and replaced with a breast implant after the local skin and soft tissues have relaxed. A combination of latissimus dorsi flap transfer and prosthesis implantation is also a good way to address the patient’s skin soft tissue deficit. The skin island portion of the latissimus dorsi muscle flap is used to repair the skin soft tissue defect, and the carried portion of the latissimus dorsi muscle can be used to cover the lower part of the prosthesis. Although implant placement is less invasive and relatively less difficult, for most patients, breast reconstruction based on flap transfer generally has a good postoperative appearance, natural mobility, and relatively high satisfaction. The current international “gold standard” of breast reconstruction is the inferior abdominal artery perforator flap (DIEP) breast reconstruction and the transverse rectus abdominis flap (MS-TRAM) breast reconstruction with partial preservation of the rectus abdominis muscle. The former was first proposed by Professor Koshima of the University of Tokyo in 1997, and because the DIEP flap preserves all of the rectus abdominis muscle, the donor area is less deformed, the incidence of postoperative abdominal wall hernias is lower, and the patient has good abdominal wall function. However, the DIEP flap is difficult and risky because of the need to dissect the tiny penetrating branches out of the rectus abdominis muscle during surgery; there are also some patients who have difficulty in cutting the DIEP flap because of anatomical reasons. The TRAM flap, which preserves part of the rectus abdominis muscle, has the advantages of simpler and less risky surgery compared with DIEP and less donor deformity compared with the traditional TRAM flap that removes all of the rectus abdominis muscle, and thus has been advocated by many scholars. The author has done a comparative study of abdominal wall tension and rectus abdominis muscle strength in rats after DIEP and MS-TRAM flap excision and found that there was no statistically significant difference between the DIEP and MS-TRAM groups if 1/3 of the rectus abdominis muscle was preserved. It is worth pointing out that the traditional tipped TRAM flap is no longer a first-line option due to the need to carry all of the rectus abdominis muscle and therefore the donor area deformity and the patient’s postoperative abdominal wall function. The TRAM flap with a tip is actually inferior to the free TRAM flap because the source of blood supply to the flap is not physiologic (the main blood flow to the TRAM flap is from the inferior abdominal wall artery, not the superior abdominal wall artery). This is a point that many physicians tend to misunderstand. Because breast cancer patients are usually married women, using the soft tissue of the abdominal wall as the donor area can have a two-fold effect. The excess abdominal wall soft tissue is removed, resulting in a tight abdominal wall; the flap is transferred to the breast recipient area and a well-formed breast is reconstructed. If for special reasons, the soft tissue of the skin of the buttock or thigh can also be used as a source of donor area for breast reconstruction. Reconstruction of the nipple areola is usually performed about 6 months after the completion of the main breast reconstruction surgery. The reasons for this include: 1. The reconstructed breast will undergo a morphological remodeling process that will take about six months. If nipple areola reconstruction is performed when the reconstructed breast is not stable, it may result in poor placement of the reconstructed nipple areola complex. 2.After breast cancer surgery, adjuvant radiotherapy may be required, and the adjuvant treatment may also have an impact on the shape of the reconstructed breast. 3. Nipple areola reconstruction may require local flap transfer, and it is safer to perform the surgery around 6 months. The methods of nipple areola reconstruction generally include local flap transfer, skin graft, cartilage graft, etc. Because there are many departments involved in postoperative breast cancer reconstruction (breast surgery, plastic surgery, oncology, radiotherapy, radiology, etc.), it is especially important to establish a good cooperation mechanism. The ideal model of cooperation is breast surgery – plastic surgery – breast surgery. Patients are first seen in breast surgery, the diagnosis is clarified, tumor staging is performed, and the tumor surgery plan is determined. Prior to the surgery, the breast surgeon consults with the plastic surgeon to determine the surgical incision and reconstructive approach. After the breast cancer surgery is completed, the reconstructive surgery is then completed by the plastic surgeon. Because the surgical management after breast reconstruction is mainly the monitoring and management of the flap’s blood flow, this is a routine part of plastic surgery. Patients can be referred to plastic surgery after surgery. After the flap is stabilized, the patient is transferred to breast surgery to continue the treatment of breast cancer. In this way, patients can receive proper treatment in a specialized department without frequent hospital visits.