Breast reconstruction can improve the physical and psychological trauma caused by breast cancer surgery. Immediate breast re-implantation is financially and psychologically beneficial due to its one-step completion. However, due to doubts about the indications and oncological safety of postoperative IBR for breast cancer, many doctors and patients have not yet fully accepted this procedure, and this article will analyze the current status of research on this issue. I. Indications IBR can be used after breast cancer surgery, after prophylactic resection in high-risk groups, and in patients who have failed breast-conserving and radiotherapy [1]. In the past, breast reconstruction, especially IBR, was mostly used for patients with early breast cancer. In recent years, some physicians have attempted to perform breast reconstruction for patients with locally advanced breast cancer.Behnam et al [2] concluded from a retrospective study that postoperative IBR for locally advanced breast cancer does not increase postoperative complications and that adjuvant radiotherapy and chemotherapy do not significantly affect their postoperative recovery time. The majority of patients were satisfied with their reconstructed breasts and postoperative experience, and were willing to choose breast reconstruction if they had to do so again. Therefore, with advances in combination therapy, the prognosis for patients with advanced breast cancer will improve, and breast reconstruction should be part of the comprehensive treatment. Age is not a major factor affecting breast reconstruction.Lipa et al[3] conducted a retrospective analysis of 84 elderly patients who underwent breast reconstruction after mastectomy and concluded that autologous tissue breast reconstruction is a safe and successful option for women over 65 years of age. Second, it is applicable to various surgical procedures for breast cancer Breast reconstruction does not limit the type of mastectomy surgery and can be used after radical, modified radical, and breast-conserving surgery [4-6]. In particular, the use of IBR after breast-conserving surgery could make the use of breast-conserving surgery more popular. Skin-sparing mastectomy (SSM), first reported in 1991, is popular for preserving as much breast skin as possible while removing the nipple areola and biopsy localization, which is more conducive to shaping the shape of the reconstructed breast. A survey of members of the breast specialty group of the British Society for Surgical Oncology showed an increase in the proportion of members applying SSM from 21% in 1997 to 73% in 2001 [7].Patients with T1/T2, multicentric tumors, ductal carcinoma in situ (DCIS), and prophylactic mastectomy are particularly suited to this procedure. Its oncological safety in T3 tumors, on the other hand, has yet to be demonstrated.Contraindications to SSM include inflammatory breast cancer and extensive skin involvement [8].Rivadeneira et al [9] retrospectively followed and analyzed 198 women who underwent mastectomy for invasive breast cancer.At a mean follow-up of 49 months, the recurrence rate was 5,6% (4/71) in the SSM group and 3,9 % (5/127), p>0,05, therefore, SSM does not increase the local recurrence rate while improving the outcome of postoperative IBR. Detection of local recurrence is not compromised as most recurrences occur in the skin of the chest wall.The incidence of local wound complications with SSM is comparable to that without SSM.SSM allows for adequate anterior sentinel lymph node biopsy and axillary lymph node dissection. There are no postoperative contraindications to adjuvant chemotherapy or radiotherapy [10]. SSM allows for better cosmetic results than modified radical surgery, and even better if the nipple areola complex (nippleandareolacomplex, NAC) is preserved [11]. Currently, there is controversy about whether NAC preservation should be performed and how to control the indications.Hudson et al[12] concluded that the areola can be preserved if the tumor is more than 5 cm away from the NAC in patients with early-stage breast cancer.Mustonen et al[13] demonstrated that preservation of the NAC did not increase the rate of local recurrence and metastasis compared to removal of the NAC in a group of 66 patients with IBR. and metastasis rates. It is feasible to preserve the NAC at the time of IBR in patients with early breast cancer whose tumors are not located in the central region. In contrast, Cense et al [14] analyzed by searching the Medline database and concluded that the rate of nipple involvement was 58% in mastectomy specimens. The rate of nipple involvement was related to tumor size, distance of the tumor from the areola or nipple, number of positive lymph nodes, and clinical suspicion of nipple involvement. The best indication for NAC preservation is small tumors (T1) that are distant (>4-5 cm) from the nipple. However, in these patients, breast-conserving surgery has better outcomes with fewer postoperative complications and lower recurrence rates. Nipple involvement increases with larger tumors, averaging 33% for T2 tumors and more than 50% for T3, and NAC-preserving mastectomy may lead to an unacceptably high risk of local recurrence and should therefore not be advocated. Intraoperative freezing of the NAC base to screen for cases of NAC preservation [15] and intraoperative electron beam irradiation of the areolar region (ELIOT) [16] have provided new ideas for NAC preservation. Simmons proposed a modified SSM that removes the nipple while preserving the areola. It was based on a retrospective analysis of data from 217 mastectomy patients [17], which revealed a 23/217 (10, 6%) rate of nipple involvement. In the group of tumors <2 cm, tumors located in the periphery, and no more than 2 positive lymph nodes, the percentage of nipple involvement was 6, 7%. Analyzing nipple and areola involvement separately, only 2 (0, 9%) of 217 patients had areola involvement. All patients with areola involvement had stage 3 breast cancer and the tumor was located in the central region of the breast. Therefore, Simmons concluded that nipple preservation was not a reasonable option for mastectomy patients. Subsequently, Simmons et al. selectively performed areola-sparing mastectomies (ASMs) [18-19]. Patients included prophylactic mastectomy patients, patients with DCIS or small peripheral zone invasive ductal carcinomas. post-ASM IBR, excellent aesthetic results were obtained with few complications, and there were no recurrences at 2 years. Preservation of the inframammary fold (IMF) during mastectomy facilitates the postoperative outcome of breast reconstruction and is therefore mostly recommended by plastic surgeons.However, GuiGP et al [20] examined 50 IMF specimens from 42 mastectomy patients and found that 10 specimens (20%) contained breast tissue, 1 (2%) contained breast tissue and inframammary lymph nodes.3 (6%) specimens containing fibrofatty tissue without breast parenchyma had inframammary lymph nodes.One (2%) patient who underwent mastectomy for invasive ductal carcinoma had one metastatic lymph node in the IMF tissue.Whether or not the IMF contained breast tissue or lymph nodes was independent of the patient's age, body mass index, IMF volume in relation to breast volume, and the absolute size of the breast.Twenty-eight percent of IMF specimens containing breast tissue and inframammary lymph nodes, a finding that makes it necessary to reconsider the safety of retaining the IMF at the time of mastectomy. If the IMF is removed and IBR is performed, the surface fascial structures should be reconstructed to recreate the inframammary fold. Impact on postoperative adjuvant therapy for breast cancer (i) Impact on postoperative chemotherapy 1. Relationship between IBR and chemotherapy initiation time Mortenson MM et al [21] retrospectively analyzed 128 (148 sides) breast cancer patients who underwent mastectomy, and wound complications were significantly (p=0.5) increased in the IBR group (17/76, 22,3%) compared to the non-reconstructed group (6/72, 8,3%). significantly increased (p=0,02). However, these complications did not delay the initiation of postoperative chemotherapy.The results of WilsonCR et al [22] also showed that IBR does not delay adjuvant chemotherapy and does not have an adverse effect on breast cancer. 2, IBR does not increase the side effects of chemotherapy and does not need to change the dose intensity Caffo et al [23] compared the side effects of chemotherapy and the dose intensity of 52 breast cancer patients who were treated with both IBR and adjuvant chemotherapy with the application of a tissue expander after radical surgery (IBR/chemo group) and 63 patients who were treated with adjuvant chemotherapy without IBR after radical surgery (chemo group).The IBR/chemo and chemo groups were similar in the dose intensity were similar, averaging 96% and 95% of the recommended dose. Concomitant IBR and chemotherapy did not increase the incidence of chemotherapy side effects and did not require a change in dose intensity. 3, Relationship between IBR and chemotherapy duration Allweis et al [24] retrospective analysis showed that the post-mastectomy IBR + adjuvant chemotherapy group was younger than the mastectomy without reconstruction group (46 and 55 years old, respectively, p<0,001), and the chemotherapy duration in the control group was significantly longer than that in the reconstruction group (53 and 41 days, respectively, p=0,039). The type of reconstruction did not affect the duration of chemotherapy. (ii) Effect on postoperative radiotherapy Shankar et al [25] concluded that during radiotherapy tissue expanders undergo clinically undetectable changes that can lead to changes in the radiotherapy plan, changes in tissue expanders lead to a poor appearance, and shifts from the designated radiotherapy dose lead to over or under dosing of the tumor with radiotherapy. At Howard University Hospital, CT was utilized to examine the status of tissue expanders during radiotherapy to avoid radiotherapy complications due to deviations in dosimetry. Repeat dosimetry showed no change in the specified dose distribution. CT examination of the reconstructed breast provides an important quality control.KronowitzSJ et al [26] concluded that IBR should be avoided for patients known to require post-mastectomy radiotherapy, and for patients who may require this treatment, the authors [27] proposed a two-step, deferred-IBR approach that allows for optimal reconstruction in patients who are likely to require postoperative radiotherapy. Step 1 consists of a skin-sparing mastectomy with placement of a tissue expander. After pathologic results are obtained, patients who do not require postoperative radiotherapy undergo IBR (step 2), and patients who do require postoperative radiotherapy complete postoperative radiotherapy after complete evacuation of the tissue expander, followed by standard deferred breast reconstruction. With this approach, patients who do not require postoperative radiotherapy can achieve the same aesthetic results as with IBR, and patients who require postoperative radiotherapy can avoid the problems with aesthetics and implementation of radiotherapy that IBR may cause. At present, the articles about the adverse effects of IBR on radiotherapy have used prosthetic breast reconstruction, and it has not been reported whether autologous tissue breast reconstruction has adverse effects on radiotherapy. Fourth, the effect on the process of tumor evolution In a prospective study conducted by Duskova et al [28] in patients with stage I-II breast cancer, there was no symptomatic breast reconstruction triggered the progression of breast cancer. There were no significant differences in local recurrence and survival between the various breast reconstruction styles and the control group.Murphy et al [29] showed in a study of 1444 mastectomy patients that there were no recurrences in the deferred reconstruction group (0/24), 2/158 (1, 3%) in the IBR group, and 9/1262 (0, 7%) in the mastectomy without reconstruction group (p=0, 746). An analysis of another time period, 1992-2000, yielded similar findings. There was no association between local recurrence of breast cancer after mastectomy and reconstruction.A study by ChagparA et al [30] of 155 patients with chest wall recurrence (CWR) after mastectomy for breast cancer also showed that there was no significant difference between the reconstructed group (27) and the no reconstruction group (128) in terms of the timing of the CWR, its size, the number of nodules, the ulcers, the erythema, or the association of CWR with lymph node metastasis . There were also no significant differences in the risk of secondary chest wall recurrence, risk of distant metastasis, mean overall survival after chest wall recurrence, or tumor-free survival after chest wall recurrence. However, 7 cases (26%) in the reconstructed group required chest wall reconstruction compared to only 10 cases (8%) in the non-reconstructed group (p=0,013); therefore, surgical removal of chest wall recurrence and repair of the resulting defect was more complex in the reconstructed group than in the non-reconstructed group, and was more likely to require a plastic surgeon to perform chest wall repair than a simple excision or a single suture after excision. Local recurrence is usually considered to have a poor prognosis, Langstein et al [31] retrospectively analyzed 1694 patients with IBR with a local recurrence rate of 2,3% (39 patients). Of these, 72% (28 cases) were located in the skin or subcutaneous tissue, and 28% (11 cases) were located in the chest wall with skeletal or muscular involvement. Those with subcutaneous recurrences had a higher survival rate, lower metastasis rate, and higher chance of maintaining disease-free survival than those with chest wall recurrences.IBR may mask chest wall recurrences but does not delay detection of chest wall recurrences. Chest wall recurrence is closely associated with metastasis, and survival is not altered by early detection. A census of recurrence after breast reconstruction has not been established. Most recurrences in patients are detected on physical examination and confirmed by biopsy [32]. Mammography, ultrasound, MRI and CT have been used to detect the presence of recurrence in reconstructed breasts [33-36]. As the most reliable diagnostic method for recurrence after TRAM breast reconstruction, fine-needle aspiration, coarse-needle aspiration, or incisional biopsy is still performed when suspected. In conclusion, with the development of integrated oncology, IBR will become part of the comprehensive treatment of breast cancer. The oncologic safety of IBR will be better served by rigorous screening for indications for breast cancer surgery and by precise implementation of oncologic radiotherapy.