Many breast reconstruction procedures have been performed with success and satisfaction. These methods can be categorized as implant reconstruction, local tissue with implant, autologous tissue, and free flaps. Implant reconstruction, immediate or delayed, has been the easiest and most fulfilling experience for the surgeon and the patient. Local tissue with implant and autologous tissue are usually available to those patients with anterior chest tissue deficiency or those who prefer autologous tissue without the fear of implant material. Free flap reconstruction is often selected when no other procedures are appropriate for the patient. Individual procedures must be familiar to the patient and the surgeon. Other factors such as time involved, cost of hospital stay, recovery time, and associated complications are discussed in this article. Refinement and nipple areolar reconstruction are an intimate part of breast reconstruction, but these are usually the decisions made by the patient that must be respected.