BEYOND SILICONE AND FLAPS IN BREAST RECONSTRUCTION: A LITERATURE REVIEW
Keywords:
breast reconstruction, tissue engineering, adipose-derived stem cells, stromal vascular fraction, cell-assisted lipotransferAbstract
Background: Implant-based and autologous flap breast reconstruction remain standard reconstructive options, but both approaches may be limited by implant-related complications, donor-site morbidity, revision surgery, and suboptimal outcomes in irradiated tissue. Objective: This literature review summarizes clinically relevant evidence on tissue engineering, adipose-derived stem cells (ADSCs), stromal vascular fraction (SVF), cell-assisted lipotransfer, scaffolds, hydrogels, and three-dimensional (3D) printing in breast reconstruction. Methods: A narrative literature search was performed using PubMed/MEDLINE, Google Scholar, and reference-list screening up to June 2026. Search terms included breast reconstruction, tissue engineering, ADSC, SVF, cell-assisted lipotransfer, fat grafting, scaffold, hydrogel, and 3D printing. Articles were selected for clinical relevance, translational importance, and availability of verifiable bibliographic information. Discussion: Autologous fat grafting is widely used for contour refinement and soft-tissue improvement, but graft retention remains variable. ADSC- and SVF-assisted strategies may enhance graft survival through angiogenesis, adipogenesis, paracrine signaling, and extracellular-matrix remodeling, although protocols remain heterogeneous. Scaffold and hydrogel platforms may provide structural support for adipose regeneration, while 3D printing may enable patient-specific constructs. Current clinical evidence is encouraging but remains limited by small studies, heterogeneous cell-processing methods, regulatory barriers, and the need for long-term oncologic surveillance. Conclusion: Regenerative strategies should currently be considered adjuncts rather than replacements for implants and flaps. Future breast reconstruction will likely integrate conventional surgery with fat grafting, regenerative cells, biomaterials, and patient-specific scaffold design.
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