Goodbye silicone? A new era of breast reconstruction is on the horizon

Some people describe the experience of taking a walk in cold weather when they have breast implants. Silicone takes a long time to reach body temperature once out of the cold. Breast cancer survivors don't like being reminded of a disease they don't want to relive.

2 million people are diagnosed with breast cancer every year and the treatment often involves removing one breast. Most people in the UK don't have their breasts reconstructed. A group of companies want to change that by using 3D-printed implants that grow new breast tissue before they break down. "After 18 months you don't have any product in your body, that's why the implant is fully degradable," said Payen.

It could spell the end of cold breasts, as well as the high rate of surgeries associated with breast reconstruction. The Mattisse implant will be the first human trial of its kind. Soon others will follow The CEO of another startup expects to start clinical trials in two years.

Willerth, who is not involved with the companies, says it is exciting. She says that having a clinical use that doctors recognize as useful for patients is key to getting the technology out there.

In a field fraught with difficult medical compromises, the question is how big an impact the new technology will actually have.

There are two main types of breast reconstruction. flap surgery requires a flap to be taken from the stomach, thigh or back in order to perform the procedure. While there is a lot of initial surgery and a long recovery period, flaps give a good, long- lasting result.

Silicone is the most popular choice. It is easy and straightforward, which makes it appealing to cancer patients who can't have or mentally can't face having their tissue removed. The University of Bristol and the Bristol Breast Care Centre have oncoplastic surgeons. It is quite risky. There is a small chance that an implant will be lost.

Silicone implants have had their fair share of scandals, including the 2010sPIP scandal, in which a major implant manufacturer was found to have made its implants of shoddy silicone, and the 2018 Allergan scandal, in which popular textured implants were found to have been made with a different type of A study done in the US last year shows that the idea of having a foreign object stuck in your body is the main reason for not reconstructing.

The benefits of the different solutions without the constraints is what we want to do. A simple surgery of an implant without any foreign material can cause trouble.

There are different ways to achieve this. Healshape uses a hydrogel to 3D-print a soft implant that will gradually be colonised by the person's own fat cells, the initial batches of which are injected, while the implant disappears over six to nine months. A company called CollPlant is using a special bioink from tobacco leaves to make a human product. The CEO believes that it will change the opinion of many patients.

There is a different approach to medical care. The implant is made of a biopolymer and covered with a small flap. The flap fills the cage with fat tissue and the cage is absorbed by the body, leaving a regrown breast in its place.

A 2016 trial showed that growing breasts in a cage can work in humans. It only worked in one woman and the cages were not degradable. The leader of the trial's engineering team hopes the new trial will address some of the issues raised in the first trial. She says that it could help many women to achieve a superior reconstruction. The lattice medical cage is an improvement because it has a flat base.

People within the flat movement argue that if women were better informed, even more would opt out of reconstruction

It's not known how much the breasts will feel after being grown again. A plastic surgeon from the Maastricht University Medical Centre in the Netherlands said that reconstruction affects a mastectomy. She says that implants have a negative effect on sensation, so the feeling in the skin is less than when you have a mastectomy. It can take a few years for a flap with connected nerves to bring back feeling.

Tuinder thinks the numbness implant is due to nerve damage when the implants are put in, and because the nerves can't grow back once they are blocked by a lump of Silicone. Since there will be nothing to block the nerves, hope is that sensation will be better.

There are other recent innovations in the field. Many groups are working on a reconstruction technique using injections of the person's own fat, boosted with extra stem cells. The safety of the breasts is still being debated by medical professionals. The procedure might have to be done more than once.

Potter warns that we have a tendency to jump at new and shiny tech because of the optimism bias. She doesn't want a situation like with vaginal mesh, where in 10 years' time we find out we have done something that isn't helpful.

There are other solutions to the problems of reconstructing. A person is going flat. People within the flat movement believe that if people were better informed, they would opt out. The founder of the charity Flat Friends thinks that going flat would be an equal option.

According to Nice, doctors should be aware that some may not want reconstruction. It is presented as part of the treatment process. We have to do a mastectomy. You have to go to the doctor. We'll do reconstruction after you have your radiation. Women live for the reconstruction at the end. The finish line is signaled by it.

When only one breast is removed, some may want the other taken off to feel better, rather than having a new one made. Doctors don't want to remove a healthy breast Potter says that part of the doctors concern is that women will regret their decision. They should be supported and helped to do what they want to do.

Potter would like to see more of an alternative, like not having a mastectomy at all. She says there is no evidence that breast-conserving operations give you better cancer outcomes than mastectomies. The breast is kept even though the tumours is removed. One of her patients had a breast reduction that removed her cancer and gave her a lift. Her breasts are called silver lining.

There are a lot of options to choose from. Some charities arrange for people to have a procedure with someone who has already been through it. At the charity Keeping Abreast, show and tell sessions give people the chance to ask questions they wouldn't normally ask their doctor and see the results for themselves.

According to the all-party parliamentary group on breast cancer, knowing what you want isn't the same as having access to it. Potter says there's a big lottery. It comes from flap surgery being so involved that it often requires plastic surgeons who can do minute surgery under a microscope. Many clinics don't have such experts in-house and while the Nice guidance says people should still have the option, it limits access

The new implants will not be a problem because they are easy to put in. One hour and fifteen minutes is the time it takes for the implant to be inserted. All plastic surgeons can use it.

The new implants will need to be accessible in order to have a real impact. Potter doesn't think it's a techno- fix, it's just a potential piece in a big puzzle. She says that the implants would be an option for many women. Access, proper information, giving women choice and hopefully reducing the number of mastectomies that we need are the main advances.