Women who have had breast conservation therapy for malignancy are candidates for various surgical techniques for immediate or delayed breast reconstruction. These include local tissue rearrangement, therapeutic reduction mammaplasty, and various flap reconstruction procedures. Each technique has advantages and disadvantages, and individual patient factors, particularly breast size and resection defect size, should drive the choice among procedures. Immediate reconstruction (at the time of breast conservation surgery) is preferred over delayed reconstruction, for multiple reasons. Patients tend to be satisfied with the cosmetic outcome of these procedures, but thorough patient counseling and preop-immediate or erative planning is critical to a good result.