Many factors such as patient anatomy and personal desires as well as the need for radiotherapy have typically been used to choose the best method of whole breast reconstruction. The increase in demand for bilateral mastectomy, especially nipple-sparing mastectomy, has probably played a role in reduction of use of autologous tissue flaps for breast reconstruction. Selecting the optimal timing and technique for breast reconstruction after mastectomy requires knowledge of any anticipated oncology treatment. The advent of tabbed tissue expanders, acellular dermal matrix (ADM), and autologous fat grafting has enhanced the outcomes of implant-based breast reconstruction. The increasing use of autologous fat grafting has also contributed to enhanced aesthetic outcomes using implant-based breast reconstruction. Nipple-sparing mastectomy together with ADM more readily promotes symmetry with the contralateral normal breast when unilateral implant-based breast reconstruction is undertaken. Alloplastic tissue offers a reconstruction involving a less extensive procedure without the negative aspects of donor site morbidity.