Breast reconstruction after mastectomy is a significant aspect of reconstructive surgery, which has developed rapidly in recent decades. The goal goes beyond mere aesthetics, significantly improving the patient's quality of life. Initially, breast cancer therapy was based on demolitive techniques that altered the morphology and physiology of the anterior thoracic wall and axillary region. However, current techniques aim to minimize defacement while considering the patient's desire for good aesthetic outcomes. Breast surgery must be highly personalized, considering the stage of the neoplasia, the patient's preferences, and the oncological principles. The surgeon can choose from various techniques to achieve the best aesthetic and psychological outcomes for the patient. Breast cancer is considered a chronic disease, and reconstruction can be allowed during remission periods, even in cases of systematic diffusion. Various techniques can be used, including those that use existing tissues with simple volume integration, reconstruction through flaps and cutaneous-subcutaneous tissues, and the usage of distant flaps involving myocutaneous tissues. The choice of technique depends on the local situation left by the mastectomy, not the type of mastectomy performed. The agreement between the patient, the oncologic surgeon, and the plastic surgeon is crucial for successful breast reconstruction. The patient should be informed about what can and cannot be achieved with current techniques. Many women will settle for partial results, while others will never be fully satisfied.