Many women with early breast cancer undergo mastectomy as a consequence of an unfavorable tumor/breast ratio or because they prefer this option to breast conservation. As reported, breast reconstruction offers significant psychological advantages. Several techniques are currently available for the breast oncoplastic surgeon and offer interesting results in terms of aesthetic and patient-reported outcomes, using both breast implants and autologous tissues. On the other hand, advanced methodologies and technologies, such as reverse engineering and additive manufacturing, allow the development of customized porous scaffolds with tailored architectures, biological, mechanical and mass transport properties. Accordingly, the current research dealt with challenges, design methods and principles to develop 3D additively manufactured structures in breast reconstructive surgery.