 Introduction/Background Mastectomy may be performed to treat breast cancer [1] with some authors reporting increasing rates of mastectomy relative to breast conservation in the United States [2-4]. Mastectomy may also be performed as a prophylactic approach in women with a high lifetime risk of developing breast cancer. Mastectomy techniques have changed over time with radical mastectomy replaced by modified radical mastectomy and with options such as skin-sparing and nipple-sparing procedures now available [5]. In addition, mastectomies may be performed with or without reconstruction. Reconstruction approaches differ and may be autologous, involving a transfer of tissue (skin, subcutaneous fat, and muscle) from other parts of the body to the chest wall. Examples of autologous reconstruction include latissimus dorsi flaps, transverse rectus abdominis myocutaneous (TRAM) flaps, and variants such as deep inferior epigastric perforator flaps [1]. Reconstruction may also involve implants. Implant reconstruction may occur as a single procedure or as multistep procedures with initial use of an adjustable tissue expander allowing the mastectomy tissues to be stretched without compromising blood supply. Ultimately, a full-volume implant, which may be saline, silicone, or both, will be placed. Implant reconstruction often involves the placement of acellular matrix, which can increase risk of seroma formation and occasionally is visible on imaging. Reconstructions with a combination of autologous and implant reconstruction may also be performed. Other techniques such as autologous fat grafting may be used to refine both implant and flap-based reconstruction [6]. Although most of the breast tissue is removed after mastectomy, recurrence may occur in residual tissue. The majority of recurrences in the reconstructed breast will be found in the skin and the subcutaneous tissues followed by recurrences deep to the pectoralis muscle [7].
Imaging after Mastectomy and Breast Reconstruction.  Introduction/Background Mastectomy may be performed to treat breast cancer [1] with some authors reporting increasing rates of mastectomy relative to breast conservation in the United States [2-4]. Mastectomy may also be performed as a prophylactic approach in women with a high lifetime risk of developing breast cancer. Mastectomy techniques have changed over time with radical mastectomy replaced by modified radical mastectomy and with options such as skin-sparing and nipple-sparing procedures now available [5]. In addition, mastectomies may be performed with or without reconstruction. Reconstruction approaches differ and may be autologous, involving a transfer of tissue (skin, subcutaneous fat, and muscle) from other parts of the body to the chest wall. Examples of autologous reconstruction include latissimus dorsi flaps, transverse rectus abdominis myocutaneous (TRAM) flaps, and variants such as deep inferior epigastric perforator flaps [1]. Reconstruction may also involve implants. Implant reconstruction may occur as a single procedure or as multistep procedures with initial use of an adjustable tissue expander allowing the mastectomy tissues to be stretched without compromising blood supply. Ultimately, a full-volume implant, which may be saline, silicone, or both, will be placed. Implant reconstruction often involves the placement of acellular matrix, which can increase risk of seroma formation and occasionally is visible on imaging. Reconstructions with a combination of autologous and implant reconstruction may also be performed. Other techniques such as autologous fat grafting may be used to refine both implant and flap-based reconstruction [6]. Although most of the breast tissue is removed after mastectomy, recurrence may occur in residual tissue. The majority of recurrences in the reconstructed breast will be found in the skin and the subcutaneous tissues followed by recurrences deep to the pectoralis muscle [7].