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After pointing out the need for reconstruction of the nipple-areola complex and the restoration of symmetry between the two breasts after radical mastectomy for cancer, the paper briefly examines the techniques currently available for the achievement of these "finishing touches" that usually take longer then the primary and fundamental breast reconstruction.

After underlining the serious psychological consequences of radical mastectomy for carcinoma and the importance of breast reconstruction for the patient's complete recovery, the paper briefly reviews the main reconstruction techniques employed in restoring breast volume which is essentially achieved by inserting an artificial prosthesis below a myocutaneous skin flap often taken from the great dorsal. Some mention is also made of recently developed alternative techniques.

A careful review of the literature stimulated these comments on current developments in conservative surgery as an alternative to radical mastectomy in stage I and II breast cancer with particular reference to their implications for cosmetic rehabilitation. It is emphasised that the data so far available indicate comparable results in terms of locoregional recurrences, metastases and survival. It is also pointed out that the efficacy of the conservative techniques reflects new concepts of the natural history of breast cancer. The hope is expressed that these encouraging data will be confirmed by more extensive and systematic clinical experiment in order to minimise the indications to more radical surgery which notoriously has such devastating physical and psychological effects that it takes extremely complex and demanding plastic surgery to reshape the patient to psychological sexual and social health.

The biological and synthetic materials employed over the years for filling breasts after mastectomy or for congenital malformations are reviewed. At the start of the century, breast shape and volume were changed by adipose tissue grafts. In the 50s and 60s dermo-fibro-adipose grafts and later auto-grafts and grafts of the large epiploon were used. Synthetic materials have also developed, from early century attempts using paraffin injections to the discovery for industrial use of plastics. Following the first polyvinyl prostheses, Cronin developed silicon prostheses for medical purposes and in later years these went through numerous changes in form, volume and design up to the recent skin expanders. Polyurethane has also been used in attempts to reduce capsular retraction.