Breast Reconstruction Using a Three-Dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Based on Tissue-Engineering Principles

Several international teams are focusing on the growth of adipose tissue for breast reconstruction. Their surgical strategies are distinguished by the type of fat tissue used: transfer of nonvascularized adipose tissue (lipofilling) or local fat flap. In their very interesting article, Rehnke et al. present the first clinical results of their tissue-engineered breast reconstruction procedure using lipofilling.1 Our Mat(t)isse research project, presented below, proposes a surgical procedure for tissue-engineered breast reconstruction using a local fat flap. The Australian team of Morrison et al. obtained the proof of concept of a tissue-engineering chamber for breast reconstruction.2 The aim was to stimulate the growth of fat tissue directly in vivo, within an implantable device serving as a bioincubator. A cross-disciplinary approach led us to the creation of an absorbable implantable device, using three-dimensional printing, that serves as an incubator for the growth of a local fat flap according to the concept of the tissue-engineering chamber.3Figure 1 shows the key steps of the concept:Fig. 1.: Key steps of the Mat(t)isse concept. During surgery, both dome and base are assembled to create the tissue-engineering chamber. Within this chamber is embedded a low-volume flap of vascularized fat tissue, whose volume is approximately 15 percent of the chamber volume. This tissue-engineering chamber allows the fat tissue to grow and take up all of the available dead space. An autologous volume is then reconstructed. Synchronously, the biomaterial constituting the chamber is absorbed by the fluid environment in contact with it. Finally, only the autologous fat tissue remains at the volume of the initial chamber. Preclinical protocols in rats and pigs have found the proof of concept of Morrison et al. by documenting tissue growth within the implantable chamber in an average time of 90 days during magnetic resonance imaging follow-up.3 Several paramammary pedicles allow the raising of local fat flaps that can be used in our Mat(t)isse project, including flaps based on a perforator of the internal or external thoracic pedicle, the deep upper epigastric pedicle, or the lateral intercostal pedicle, for example.4,5 The accompanying video presents the different steps of a Mat(t)isse surgical procedure on an anatomical subject. [See Video (online), which demonstrates the 12 steps for a Mat(t)isse surgical procedure.]: {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"This video presents the steps of a Mat(t)isse surgical procedure on an anatomical subject. Steps 1, 2, 3, and 4 concern the preliminary subcutaneous mastectomy and then the preoperative markings for the flap raising. Steps 5 and 6 show the raising of the local flap. Steps 7 through 12 show the use of the device, its insertion, and then the closure.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_q3srlneg"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Steps 1, 2, 3, and 4 concern the preliminary subcutaneous mastectomy and then the preoperative markings for the flap raising. Steps 5 and 6 show the raising of the local flap. Steps 7 through 12 show the use of the device, its insertion, and then the closure. The use of a local fat flap seems to us an interesting alternative to be considered. Indeed, the major disadvantage of the use of lipofilling compared to the local fat flap is the need to perform several lipofilling procedures. Our Mat(t)isse procedure would allow an autologous breast reconstruction, without any sequelae of the donor site and without foreign bodies, in a single procedure. DISCLOSURE Drs. Marchetti and Guerreschi are co-inventors of a patent application that covers the design of the tissue engineering chamber and are consultants for Lattice Medical. The remaining authors have no financial or commercial conflicts of interest in relation to this work. César Depoortère, M.D.Pierre Faglin, M.D.Salengro HospitalDepartment of Plastic SurgeryLille University HospitalINSERMCHU Lille Lucie Dekerle, M.B.B.S.INSERMCHU Lille Philippe Marchetti, M.D., Ph.D.Center de Biologie Pathologie Véronique Duquennoy-Martinot, M.D., Ph.D.Salengro HospitalDepartment of Plastic SurgeryLille University Hospital Pierre Guerreschi, M.D., Ph.D.Salengro HospitalDepartment of Plastic SurgeryLille University HospitalINSERMCHU LilleLille, France