Breast reconstruction surgery remains a relatively modern development when compared to the history of surgery. The first radical mastectomy for breast cancer was described in the 1880s by Halsted. However, breast reconstruction did not gain widespread acceptance until the 20th century due to Halsted’s belief that it would be a “violation of the local control of the disease”, and concerns that a reconstructive procedure may mask evidence of local cancer recurrence and unfavourably modify the course of the disease. As new evidence emerged to contradict Halsted, there has been paradigm shift and development in a far less aggressive breast-conserving approach to treatment. These milestones in breast surgery over the last century have paved the way for the advancement of breast reconstructive techniques, with the aim of maintaining natural symmetry, feel, and aesthetics. As a result, plastic surgery has become an increasingly important complement in the comprehensive management of breast cancer. Various reconstructive techniques exist in modern practice, ranging from autologous tissue transfer techniques that have been established and refined, to synthetic implant-based and tissue expander reconstruction. The choice and appropriateness of each reconstructive technique requires a thorough discussion between patient and surgeon. A historically admonished practice has now become a pillar in modern breast cancer surgery to improve patient care and satisfaction.