Three-dimensional (3D) bioprinting is an evolving biofabrication approach in regenerative medicine with the potential to overcome many limitations of conventional reconstructive techniques, including donor-site morbidity, limited tissue availability, and suboptimal restoration of form and function. Recent advances in biofabrication have accelerated the development of patient-specific living constructs for reconstructive applications. This narrative review synthesizes contemporary evidence on the use of 3D bioprinting in reconstructive surgery, emphasizing developments most relevant to plastic surgery. The current literature on bioprinting technologies, bioinks, tissue-specific applications, translational studies, and regulatory considerations was critically reviewed. Significant progress has been achieved in the bioprinting of skin, cartilage, bone, osteochondral tissues, vascularized constructs, and composite craniofacial tissues. Advances in extrusion-, inkjet-, laser-, and stereolithography-based printing, together with increasingly sophisticated natural and synthetic bioinks, have improved construct fidelity, cellular viability, and tissue-specific functionality. In situ bioprinting, patient-specific computer-aided design, and hybrid biomaterial strategies have further expanded the clinical potential of bioprinted tissues. Despite these advances, major barriers remain, including inadequate vascularization of large constructs, limited mechanical maturation of load-bearing tissues, manufacturing standardization, regulatory uncertainty, and the absence of robust long-term clinical outcomes. Three-dimensional bioprinting is enabling increasingly personalized tissue fabrication, although most applications remain preclinical. Clinical translation will require further advances in biomaterials, vascular engineering, manufacturing standardization, and regulatory science.
R. Hirani, Sarina Iraj, Mathew Trandafirescu et al.· Cells· 0 citations
BACKGROUND
Improvements in mastectomy techniques have led to increased adoption of single-stage direct-to-implant (DTI) breast reconstruction, yet whether it functions as a true "one-and-done" pathway remains uncertain.. This study evaluates reoperation rates for prepectoral DTI versus two-stage implant-based breast reconstruction (IBBR).
METHODS
A retrospective review was conducted of all prepectoral breast reconstructions from 2017-2024. Data collected included demographics, operative characteristics, and complications. Complications were categorized as major (readmission/reoperation), minor (managed outpatient), or aesthetic.
RESULTS
A total of 552 breasts (333 patients) were included: 229 DTI and 323 two-stage reconstructions. DTI patients had lower BMI (23.8 vs. 26 kg/m²,p<0.05), lower mastectomy weights (561.1g vs. 653.4g,p<0.05), and more prophylactic mastectomies (59.4% vs. 33.7%, p<0.05). Major complications were significantly lower in DTI (7.0% vs. 19.8%, p<0.05), as were minor complications (21.0% vs. 30.7%,p<0.05). Aesthetic revisions were more common in DTI (15.3% vs. 5.3%,p<0.05), predominantly for fat grafting. Across the reconstructive course, the mean number of surgeries per breast was 1.2 for DTI vs. 2.3 for two-stage (p<0.05).
CONCLUSIONS
Prepectoral DTI reconstruction can result in significantly fewer complications and total operations compared to two-stage IBBR. Although aesthetic reoperations were more common in DTI, they were minor and elective. To our knowledge, this is the first and largest prepectoral-only study evaluating revision burden, providing plane-specific data to guide operative planning and patient counseling. Patients can be counseled that DTI reconstruction offers a safe and aesthetically favorable option, with a reduced total number of surgeries and lower complication rates compared to traditional two-stage reconstruction.
Chris Amro, C. Boyd, Kshipra Hemal et al.· Plastic and Reconstructive S...· 0 citations
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