Preclinical Study of Radiation on Fat Flap Regeneration under Tissue-engineering Chamber: Potential Consequences for Breast Reconstruction

Abstract

Background: Use of a tissue-engineering chamber (TEC) for growth of fat flap is a promising approach for breast reconstruction. Here, we evaluated in a preclinical model the effects of radiation on adipose tissue growth either before or after 3D-printed bioresorbable TEC implantation. Methods: Twenty-eight female Wistar rats were distributed into three groups: TEC implantation as nonirradiated controls (G1), TEC insertion followed by irradiation 3 weeks later (G2), and irradiation 6 weeks before TEC insertion (G3). G2 and G3 received 33.3 Gy in nine sessions of 3.7 Gy. Growth of the fat flap was monitored via magnetic resonance imaging. At 6 months after implantation, fat flaps and TECs were harvested for analysis. Results: Irradiation did not alter the physicochemical features of poly(lactic-coglycolic acid)-based TECs. Compared with G1, fat flap growth was significantly reduced by 1.6 times in irradiated G2 and G3 conditions. In G2 and G3, fat flaps consisted of mature viable adipocytes sustained by CD31+ vascular cells. However, 37% (3 of 8) of the G2 irradiated adipose tissues presented a disorganized architecture invaded by connective tissues with inflammatory CD68 + cells, and the presence of fibrosis was observed. Conclusions: Overall, this preclinical study does not reveal any major obstacle to the use of TEC in a radiotherapy context. Although irradiation reduces the growth of fat flap under the TEC by reducing adipogenesis and inducing inconsistent fibrosis, it does not impact flap survival and vascularization. These elements must be taken into account if radiotherapy is proposed before or after TEC-based breast reconstruction.

Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction

“…The goal of the reconstruction is to provide a well-vascularized tissue, as well as an easily conformable entity to reconstruct an anatomic appearance. It is possible that in the future, more advanced acellular dermal matrixes [ 65 ] or 3D- and 4D-printed tissue engineering chambers [ 66 , 67 ] could be developed to effectively fill the cavity, serving as an additional valuable tool; however, perforator flaps, which provide both the necessary volume and skin quality for coverage, appear to be a durable and reliable solution. More studies may be needed to help draw an algorithm for perioperative selection of the flap type, taking into account the skin paddle of a specific venous territory [ 68 ]; however, we believe that the results presented in this study should prompt plastic surgeons involved in these complex reconstructions to opt for propeller perforator flaps.…”

Engineering 3D-Printed Bioresorbable Scaffold to Improve Non-Vascularized Fat Grafting: A Proof-of-Concept Study

“…Then, tissues were harvested and immediately fixed with 10% paraformaldehyde overnight before paraffin embedding. Histological specimens were routinely stained with hematoxylin and eosin or Masson's trichrome, as previously detailed [25,26]. Histological tissues were also stained with anti-perilipin antibody, TUNEL staining, anti-CD31 antibody, or anti-CD68 antibody, as previously described [25,26].…”