When you think about breast implants, what comes to mind? A super fake-looking pair of hemispheres? Lots of plastic and silicone? Or something that’s rock-hard from fibrosis, à la The Cool Mom from Mean Girls?
mm, mom hugs.
No one wants failed boobs. People want any procedure done to have as natural-looking results as possible, as if they had nothing done at all. And breast implant procedures aren’t just limited to women looking to bump up their A cups to a DD. Women who have undergone mastectomies also want procedures that can give them back their sense of womanhood and well-being.
The most common breast implant procedures today involve the insertion of silicone implants because they mimic best the feeling of a natural breast. There are saline implants and autologous tissue flap graft procedures as well, but silicone is still the standard. However, there is always the risk of rejection by the body; capsular contracture is the most common complication, where chronic foreign body response occurs and leads to scar tissue formation, pain, and tissue deformities.
This isn’t pretty!
So there’s this other procedure called lipofilling, where adipose tissue is harvested from the patient and injected into the breast. The success of the procedure depends on the presence of adipose-derived stem cells because the proliferation and differentiation of the stem cells into adipocytes and other cells. They aid in angiogenesis and adipogenesis through the release of growth factors and differentiation into mature fat cells.
This procedure is more useful for smaller-scale aesthetic corrections as opposed to a whole reconstruction because graft volume loss post-transplantation due to mechanical stress is a huge limitation. That’s where tissue engineering comes in.
Current methods of breast tissue engineering start with a scaffold made of either natural or synthetic materials in the form of hydrogels or solid scaffolds. One example of a natural scaffold is made of collagen in a hydrogel form. Collagen is a natural biopolymer present in the ECM, and in this case, it is used in sponge form for adipose tissue engineering to facilitate seeding and differentiation of preadipocytes into adipocytes. Other hydrogels are developed to mimic the ECM with the mechanical and chemical cues for cellular attachment and growth; Matrigel is one basement membrane preparation composed of collagen, laminin, and perclan extracted from a mouse sarcoma cell line. Myogel is a skeletal muscle extract.
In terms of solid scaffolds, decellularized human and porcine adipose tissue has been shown to have high stability and tissue compatibility. These retain key ECM components that create a conducive microenvironment for adipose-derived stem cells to recruit host cells for angiogenesis and adipogenesis. The local biochemical and biomechanical environment is key for adipogenesis with gels and scaffolds to match the stiffness of normal fat tissue.
Other biomaterials that have been covered previously are also applicable to tissue engineering; hyaluronic acid, polyethylene glycol (PEG), polyglycolactide (PGA, polylactide (PLA) and their copolymer (PLGA). There are also 3D-printed scaffolds in development that allows for the customization of micro-and macro-architectural properties of the biomaterials used.
Any implanted material needs to be biocompatible, sterile, and deformable while maintaining size and shape to maximize comfort and the natural feel for breast implant recipients. It should also allow for physicians to perform diagnostic imaging to keep track of patient progress. A combination of the materials previously mentioned, such as lipofilling and tissue engineering, will produce the most satisfactory results for patients.
Times have changed since the mom in Mean Girls got her boobs done, and it’s past due for women who have survived breast cancer to receive something that will get their self-confidence and well-being back on track.
sources: https://www.liebertpub.com/doi/full/10.1089/ten.TEB.2016.0303?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed& https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366692/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131273/#__sec5title