Breast Reconstruction with a Tissue Engineering and Regenerative Medicine Approach (Systematic Review)

Abstract

Current techniques for breast reconstruction include an autologous-tissue flap or an implant-based procedure, although both can impose further morbidity. This systematic review aims to explore the existing literature on breast reconstruction using a tissue engineering approach; conducted with the databases Medline and Embase. A total of 28 articles were included, mainly comprising of level-5 evidence with in vitro and animal studies focusing on utilizing scaffolds to support the migration and growth of new tissue; scaffolds can be either biological or synthetic. Biological scaffolds were composed of collagen or a decellularized tissue matrix scaffold. Synthetic scaffolds were primarily composed of polymers with customisable designs, adjusting the internal morphology and pore size. Implanting cells, including adipose-derived stem cells, with combined use of basic fibroblast growth factor has been studied in an attempt to enhance tissue regeneration. Lately, a level-4 evidence human case series was reported; successfully regenerating 210 mL of tissue using an arterio-venous pedicled fat flap within a tissue engineering chamber implanted on the chest wall. Further research is required to evaluate whether the use of cells and other growth factors could adjust the composition of regenerated tissue and improve vascularity; the latter a major limiting factor for creating larger volumes of tissue.

Keywords: Adipose-derived stem cells; Breast reconstruction; Cellular therapy; Regenerative medicine; Scaffold; Stem cells; Tissue engineering.

Figure 1

A flow chart illustrating the database search and exclusion criteria to identify the articles included.

Figure 2

H&E stained cross sections demonstrating tissue scaffold. (a, b) At 6 weeks. avl = arteriovenous loop. The arrows demonstrate areas of tissue growth within the nubbins of the TEC and the diamond areas of un-remodeled Adipogel. (b) the brown staining demonstrating viable fat cells. (c, d) exhibit scaffold at 12 weeks with substantially more viable adipose tissue. Source Debels

Figure 3

“Overall concept of the prevascularization and delayed fat injection concept.” An empty scaffold is implanted onto the chest wall, and after a period of prevascularization, lipoaspirate is injected into the construct. Source: Chhaya et al.

Figure 4

(a) The decellularization protocol. (b–e) The scanning electron microscope (SEM) analysis of the constructs (scale bars: 100 µm for (b and c) 10 µm for (d and e)). (f) Successful decellularization with a reduction in DNA content. (g, p) The adipocyte infiltration at 2 weeks and 4 weeks post implantation respectively. The hybrid ECM-OPAAF construct shows superior adipoinductive capacity. Source Rossi et al.

Figure 5

(a) demonstrates the 210 cm³ TEC. (b–d) The TAP fat flap design, the surgical procedure and the final result prior to closing. Source Morrison et al.

Figure 6

At 12 months, the tissue generated exhibits adipose tissue covered by a fibrous capsule. Source Morrison et al.