**4. Conclusion**

After breast cancer and nipple-sparing surgical approaches became active, cosmetic expectations have increased even more. The introduction of ADM, especially in the sense of emergency breast reconstruction, has been groundbreaking. Despite its complications such as infection and seroma, ADM is successful in its use with well-fed flaps that cover it. The main problem is economic, although it is human-induced, which is more flexible in the choice of ADM.

In terms of psychological recovery and patient satisfaction, the use of ADM and biomaterials among the reconstruction options close to breast normal tissue and appearance is becoming more common with contributions to the literature. It is possible to contribute to breast volume and increase skin quality in the early and late periods with fat injection into the breast. What is discussed at this stage is what can be done additionally for fat survival.

3D printer technology aims to produce serial and personalized bioprints at low cost and to make them widely used in clinics. With biomaterials produced in this way, it may be possible to minimize volume loss by increasing the vitality and vascularity of fat cells injected for breast reconstruction.

## **5. Reconstruction: when and how?**

One of the most controversial issues in reconstructions after breast cancer diagnosis is the timing of surgery. In any case, the most important issue to be considered is that the patient can start oncological treatment as soon as possible if needed. It is recommended to start adjuvant radiotherapy within 8–12 weeks after the surgery. Late radiotherapy is determined to have a risk of recurrence [92].

This situation leads us to the following question: Would the reconstruction be performed together with tumor surgery or the reconstruction after the completion of oncological treatment (especially chemoradiotherapy) would be more appropriate?

The most important factor in choosing early or late treatment is whether the patient needs radiotherapy or not. Some of the publications in the literature state that the complication and success rates in patients who underwent simultaneous repair and received RT are close to or at an acceptable level when compared to late repair [93– 96]. There are some publications stating that early repair has more successful results [97]. However, many publications show that simultaneous repair is associated with a higher risk of complications than late repair in patients who will receive radiotherapy [98–101].

When the advantages of early treatment are stated, one of these advantages is that it does not require additional surgery, and it is a relatively easy surgery because it is performed before the tissue damage is caused by radiotherapy. The most important disadvantages are that a possible complication may delay the patient's receiving

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

radiotherapy and additional complications may occur with radiotherapy. The general belief is that although there may be a delay in initiating RT treatment due to complications from time to time, the simultaneous repair usually does not cause a delay in initiating RT [102]. Simultaneous repair may be a good alternative, especially when autologous reconstruction options are preferred [93, 96].

The biggest advantage of the delayed treatment is that RT treatment has been completed and the reconstruction can be spread throughout the process. The most important problem is that the tissues damaged after RT make surgery significantly more difficult, and patients who have had mastectonia spend a long time until they have definitive reconstructive surgery.

In the statement published by the Oncoplastic Breast Consortium [103], some current recommendations were included.

If late repair is performed, definitive surgery should be performed at least 6–12 months later.

Waiting 6–12 months for fat graft applications.

Concomitant repair may affect the onset of RT in some patients, however, it generally does not cause a delay in the onset of therapy.

RT is not an absolute contraindication for simultaneous implant repair, but it has a higher risk of complications.

The fact that the patient will receive chemotherapy is another factor affecting the chance of success. Different chemotherapeutic drugs have been demonstrated to have different complication rates [104].

If the patient has advanced breast cancer such as inflammatory breast cancer, it would be better for patient safety to wait at least 1 year from the completion of treatment and confirm that there is no recurrence [105].

Many surgeons also have reservations about fat graft applications. The idea that the adipose stem cells contained in the fat graft may stimulate the proliferation of cancer cells makes many surgeons hesitant in the application of fat grafts. However, studies indicate that fat graft applications do not increase recurrence and metastasis [106].

Another drawback of fat grafting is that it may complicate the radiological followup of the patient. However, in general, the abnormal radiological images encountered in these patients are observed far from areas containing fat grafts, and it is most likely due to changes that occur as a result of surgery rather than fat grafting [107].

### **Conflict of interest**

The authors declare no conflict of interest.

*Breast Cancer Updates*
