Laboratory of Bioregenerative Medicine & Surgery, Division of Plastic Surgery, Weill Cornell Medicine, New York, NY, United States of America.
Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America.
J Plast Reconstr Aesthet Surg. 2021 Oct;74(10):2596-2603. doi: 10.1016/j.bjps.2021.03.010. Epub 2021 Mar 24.
Nipple reconstruction is the essential last step of breast reconstruction after total mastectomy, resulting in improved general and aesthetic satisfaction. However, most techniques are limited by secondary scar contracture and loss of neo-nipple projection leading to patient dissatisfaction. Approximately, 16,000 patients undergo autologous flap breast reconstruction annually, during which the excised costal cartilage (CC) is discarded. We propose utilizing processed CC placed within biocompatible 3D-printed external scaffolds to generate tissue cylinders that mimic the shape, size and biomechanical properties of native human nipple tissue while mitigating contracture and projection loss.
External scaffolds were designed and then 3D-printed using polylactic acid (PLA). Patient-derived CC was processed by mincing or zesting, then packed into the scaffolds, implanted into nude rats and explanted after 3 months for volumetric, histologic and biomechanical analyses. Similar analyses were performed on native human nipple tissue and unprocessed CC.
After 3 months in vivo, gross analysis demonstrated significantly greater preservation of contour, projection and volume of the scaffolded nipples. Mechanical analysis demonstrated that processing of the cartilage resulted in implant equilibrium modulus values closer to that of the human nipple. Histologic analysis showed the presence of healthy and viable cartilage after 3 months in vivo, invested with fibrovascular tissue.
Autologous CC can be processed intraoperatively and placed within biocompatible external scaffolds to mimic the shape and biomechanical properties of the native human nipple. This allows for custom design and fabrication of individualized engineered autologous implants tailored to patient desire, without the loss of projection seen with traditional approaches.
乳房重建术后的乳头重建是必不可少的最后一步，可提高整体和美学满意度。然而，大多数技术都受到继发性瘢痕挛缩和新乳头突出度丧失的限制，导致患者不满意。每年大约有 16000 名患者接受自体皮瓣乳房重建，在此过程中切除的肋软骨（CC）被丢弃。我们建议利用处理过的 CC 放置在生物相容性的 3D 打印外部支架内，以生成组织圆柱体，模拟天然人乳头组织的形状、大小和生物力学特性，同时减轻挛缩和突出度丧失。
外部支架经过设计，然后使用聚乳酸（PLA）进行 3D 打印。患者来源的 CC 通过切碎或切丝进行处理，然后填充到支架中，植入裸鼠体内，3 个月后取出进行体积、组织学和生物力学分析。对天然人乳头组织和未处理的 CC 进行了类似的分析。
体内 3 个月后，大体分析显示支架乳头的轮廓、突出度和体积保持得更好。力学分析表明，软骨的处理导致植入物平衡模量值更接近人乳头的模量值。组织学分析显示，在体内 3 个月后，有健康和存活的软骨存在，被纤维血管组织包裹。
自体 CC 可以在术中进行处理，并放置在生物相容性的外部支架内，以模拟天然人乳头的形状和生物力学特性。这允许根据患者的需求进行定制设计和制造个体化的工程自体植入物，而不会像传统方法那样导致突出度丧失。
