State of Research on Tissue Engineering with 3D Printing for Breast Reconstruction.

Abstract

<b>Background:</b> Three-dimensional (3-D) printing paired with tissue-engineering strategies promises to overcome the volume, contour, and donor-site limitations of traditional breast reconstruction. Patient-specific, bioabsorbable constructs could enable one-stage procedures that better restore aesthetics and sensation. <b>Methods:</b> A narrative review was conducted following a targeted PubMed search (inception-April 2025) using combinations of "breast reconstruction," "tissue engineering," "3-D printing," and "scaffold." Pre-clinical and clinical studies describing polymer-based chambers or scaffolds for breast mound or nipple regeneration were eligible. Data was extracted on scaffold composition, animal/human model, follow-up, and volumetric or histological outcomes. <b>Results:</b> Forty-three publications met inclusion criteria: 35 pre-clinical, six early-phase clinical, and two device reports. The predominant strategy (68% of studies) combined a vascularized fat flap with a custom 3-D-printed chamber to guide adipose expansion. Poly-lactic acid, poly-glyceric acid, poly-lactic-co-glycolic acid, poly-4-hydroxybutyrate, polycarbonate, and polycaprolactone were the principal polymers investigated; only poly-4-hydroxybutyrate and poly-lactic acid have been tested for nipple scaffolds. Bioabsorbable devices supported up to 140% volume gain in large-animal models, but even the best human series (≤18 months) achieved sub-mastectomy volumes and reported high seroma rates. Mechanical testing showed elastic moduli (5-80 MPa) compatible with native breast tissue, yet long-term load-bearing data are scarce. <b>Conclusions:</b> Current evidence demonstrates biocompatibility and incremental adipose regeneration, but clinical translation is constrained by small sample sizes, incomplete resorption profiles, and regulatory uncertainty. Standardized large-animal protocols, head-to-head polymer comparisons, and early human feasibility trials with validated outcome measures are essential next steps. Nevertheless, the convergence of 3-D printing and tissue engineering represents a paradigm shift that could ultimately enable bespoke, single-stage breast reconstruction with superior aesthetic and functional outcomes.