**3.8 Fat injection**

As it is known, breast tissue is a common component of glandular tissue and adipose tissue. The most important problem encountered in replacing the formed defect with only fat is the inability to maintain resorption and adequate volume. Adipose-derived stem cell (ADSC) is widely used in breast reconstruction for both the awakening of autologous tissue sensation and contour correction after implant placement. When fat is enriched with ADSC, these cells can transform into new adipocytes, thus producing biocompatible, nonimmunological tissues. Likewise, studies are showing that the addition of SVF further increases angiogenesis in terms of interaction between endothelial precursor cells (**Figures 3**–**6**) [80, 88].

Studies continue to determine whether these cells increase the risk and recurrence of cancer with their secondary paracrine and autocrine effects after fat injection into the breast, which has become increasingly popular because it is more physiological [76, 78]. Insufficient follow-up time and the lack of clinical cases due to biases are among the study barriers.

**Figure 3.** *Fat ready for injection after centrifugation.*

**Figure 4.** *Fat injection into the breast.*

**Figure 5.** *Fat enriched with the stromal vascular fraction.*

#### **Figure 6.** *Cell counter device.*

It is accepted that fat injection should be done in the form of repetitive injections, rather than a sufficient amount in a single session in breast reconstruction. It should be kept in mind that the formation of sebaceous cysts and microcalcifications after excessive injections may lead to misleading results in the follow-up of malignancy [76, 80, 89].

## **3.9 Acellular dermal matrix**

The main use of ADM in breast reconstruction is to provide more support and to minimize ripling and implant exposure. Especially in post-tissue expander implant applications, wrapping the implant with ADM reduces the frequency of complications compared to the traditional technique.

The aim is to improve scaffold fabrication techniques, increase tissue similarity and compatibility, and find inexpensive means of obtaining and selling. In this way, the frequency of use can be increased.

Concurrent contralateral mastectomy rates have also increased with breastconserving surgery. In general, the favorite approach is to place the implant in the pouch designed in the subpectoral plane, still in the reconstruction phase. In this way, while sufficient muscle tissue covers the upper pole of the implant, the implant contacts the skin at the inferior pole, and after a while, the expansion mechanism thins the skin and prepares the ground for exposure [90]. In addition to the development of implant technologies in recent years, the use of ADM has decreased the exposure rate by increasing the safety of the implanted pouch. At the same time, it

*Solutions in Breast Reconstruction DOI: http://dx.doi.org/10.5772/intechopen.109782*

supports single-session approaches by providing contour regularity [91]. Closing the subpectorally placed implants by suturing ADM to the inferior wall of the pectoral muscle provided more esthetically meaningful results. Another advantage of ADM in

**Figure 7.**

*Prevention of expansion with polypropylene mesh.*


#### **Table 1.**

*ADM products in breast reconstruction.*

breast reconstruction is improved tissue expansion and increased volume. In addition, ADM itself can produce a fibrotic reaction. Studies on the reasons for this focus on dead space between the flap and ADM, formation of seroma, placement in an infected area, or insufficient perfusion [84]. In titanium-coated polypropylene meshes, the chance of tissue expansion is lower due to the stretch of the polypropylene (**Figure 7**) (**Table 1**).
