Engineered silk matrix as a substitute for acellular dermal matrix in breast reconstruction surgery

Implant-based breast reconstruction is a common standard of care for breast cancer patients following mastectomy. To support implant weight and placement, surgeons utilize autologous tissues, acellular dermal matrices (ADMs), or synthetic meshes. While ADMs provide structural support, they present significant risks, including infection transmission and seroma. Conversely, synthetic meshes exhibit poor cellular adhesion, leading to inadequate tissue integration. To address these challenges, there is a need for a matrix that enhances tissue integration while minimizing infection risks and other complications. Silk fibroin (SF), a natural biopolymer, possesses excellent biocompatibility and mechanical properties. This study introduces a novel engineered silk matrix (ESM) as an advanced solution for soft tissue regeneration, specifically in breast reconstruction surgery. The present study establishes the safety of ESM and evaluates its potential a tissue regeneration matrix through extensive in-vitro and in-vivo analyses. In-vitro assays demonstrated superior cellular adhesion, proliferation of human mammary fibroblast cells (HMFCs), collagen deposition and angiogenesis in ESM compared to collagen matrices and ADMs. Safety assessments, conducted in accordance with ISO 10993 guidelines, confirmed non-cytotoxic nature of ESM. Furthermore, subcutaneous implantation revealed no systemic toxicity or adverse tissue reactions. In-vivo studies utilizing a Yorkshire pig model of simulated breast reconstruction surgery, demonstrated superior performance of ESM over collagen matrices in tissue regeneration. The findings showed enhanced fibroblast density, increased collagen deposition, and improved vascularization. These results suggest that ESM is a safer and more effective alternative to ADMs in breast reconstruction, with the potential to revolutionize post-mastectomy care for breast cancer patients.