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Abstract
Complete removal of cancerous tissue and preservation of breast cosmesis with a single breast conserving surgery (BCS) is essential for surgeons. New and better options would allow them to more consistently achieve this goal and expand the number of women that receive this preferred therapy, while minimizing the need for re-excision and revision procedures or more aggressive surgical approaches (i.e., mastectomy). We have developed and evaluated a regenerative tissue filler that is applied as a liquid to defects during BCS prior to transitioning to a fibrillar collagen scaffold with soft tissue consistency. Using a porcine simulated BCS model, the collagen filler was shown to induce a regenerative healing response, characterized by rapid cellularization, vascularization, and progressive breast tissue neogenesis, including adipose tissue and mammary glands and ducts. Unlike conventional biomaterials, no foreign body response or inflammatory-mediated “active” biodegradation was observed. The collagen filler also did not compromise simulated surgical re-excision, radiography, or ultrasonography procedures, features that are important for clinical translation. When post-BCS radiation was applied, the collagen filler and its associated tissue response were largely similar to non-irradiated conditions; however, as expected, healing was modestly slower. This in situ scaffold-forming collagen is easy to apply, conforms to patient-specific defects, and regenerates complex soft tissues in the absence of inflammation. It has significant translational potential as the first regenerative tissue filler for BCS as well as other soft tissue restoration and reconstruction needs.
Highlights
Complete removal of cancerous tissue and preservation of breast cosmesis with a single breast conserving surgery (BCS) is essential for surgeons
For BCS, complete removal of cancerous tissue and preservation of breast shape, appearance, and consistency in a single surgery are paramount to achieving satisfactory outcomes and patient quality of life
The viscous liquid could be injected into various geometries, where it conformed to the shape prior to transitioning into a physically-stable, fibrillar collagen scaffold (Fig. 1b, Supplementary Video S1)
Summary
Complete removal of cancerous tissue and preservation of breast cosmesis with a single breast conserving surgery (BCS) is essential for surgeons. When post-BCS radiation was applied, the collagen filler and its associated tissue response were largely similar to non-irradiated conditions; as expected, healing was modestly slower This in situ scaffold-forming collagen is easy to apply, conforms to patient-specific defects, and regenerates complex soft tissues in the absence of inflammation. Surgical wound follows, initially with a seroma or hematoma forming in the defect, followed by scar formation and contraction It is extremely challenging, if not impossible, to predict the cosmetic outcome of BCS, especially given significant patient variation in breast tumor size, shape, and location, and the unpredictable nature of the tissue repair process, which is compounded by the effects of adjunct radiation therapy. Published clinical studies indicate that both surgeons and patients have been uniformly dissatisfied with BioZorb since this implant is relatively expensive, does not significantly improve outcomes, and gives rise to a hard, palpable lump that lasts for up to 2.8 years and causes patient discomfort[16,17]
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