From silicone to hydrogel: How breast implants are going natural

18 Apr 2018

Dr Niamh O’Halloran is a PhD researcher in the discipline of surgery at the Lambe Institute for Translational Research at NUI Galway. Image: NUI Galway

Dr Niamh O’Halloran of NUI Galway is using her expertise in biomedical research to offer natural implants to women who have undergone a mastectomy.

While not all diagnoses of breast cancer require the removal of the breast tissue – known as a mastectomy – many women across the world require the procedure to prevent the spread of cancerous cells to other parts of the body.

This can lead to many of these women seeking subsequent surgery to receive implants to restore their natural shape, but it has become apparent that the current generation of silicone implants is quickly becoming obsolete.

That is why Dr Niamh O’Halloran of NUI Galway is seeking to find an alternative that actually works with the patient and eliminates the drawbacks of silicone implants.

Having obtained her degree in medicine in 2014 and a master’s degree in surgery in 2015, O’Halloran is currently completing her PhD in ‘Novel Strategies for Post-Mastectomy Breast Reconstruction’ at the Lambe Institute for Translational Research.

During the course of her research, she was awarded the Allergan Innovation Award in 2017 for her work on the use of hydrogels in adipose tissue engineering for breast regeneration.

Last year, she also won the Society of Academic and Research Surgery Future Projects Prize for her work on investigating the oncological safety of adipose-derived stem cells harvested from breast cancer patients.

What inspired you to become a researcher?

From an early age, I have been fascinated by human biology and in the treatment of disease. I also wanted a job that involves working with people, so I chose medicine as a career path.

During medical school, I thoroughly enjoyed my surgical rotations, particularly as it is one of the more practical and hands-on areas of medicine. I was also fascinated by how quickly the field evolves and how surgeons are constantly striving to develop new methods of treating their patients, and devising new and exciting technology.

The field of regenerative medicine and tissue engineering is rapidly evolving and will be central to both medical and surgical specialties in the coming decades. Clinicians with an interest and experience in research will be central to translating this new technology from the bench to the bedside.

Can you tell us about the research you’re currently working on?

My research is in the area of developing novel strategies for breast reconstruction post-mastectomy.

Mastectomy can be a disfiguring operative procedure, resulting in significant physical and psychosocial issues for breast cancer patients. Immediate breast reconstruction post-mastectomy offers psychosocial and aesthetic benefits, and silicone implants are the most widely used method of breast reconstruction today.

However, they are associated with significant complications, such as inappropriate breast reconstruction volume and texture, infection, rupture through the skin, capsular contracture, and the need for replacement every five to 10 years.

My research is in the field of adipose tissue engineering and development of an implant coating composed of fat cells delivered within a biomaterial called a hydrogel, which itself is composed of proteins naturally occurring within the body.

This tissue-mimicking coating is comparable to breast tissue in texture and appearance, resulting in a more realistic and texturally accurate breast reconstruction. This innovation is superior to previous implant surface modifications as it attempts to replace like-with-like using natural biomaterials rather than synthetic chemicals with breakdown products of unknown safety.

It also proposes the eventual removal of foreign bodies as they will be replaced by native tissue, negating the need for several reoperations over the patient’s lifetime, reducing patient morbidity and healthcare cost.

In your opinion, why is your research important?

Breast cancer is a global pandemic, with the National Cancer Registry predicting that by 2020, there will be approximately 5,000 new cases in Ireland per annum.

Despite advances in oncology and the dawn of the molecular era in cancer diagnosis and treatment, surgical excision of the primary tumour is a critical oncological intervention.

40pc of breast cancer patients require mastectomy in order to adequately control their disease; however, this rate is rising with demand for contralateral and bilateral prophylactic mastectomy.

Immediate breast reconstruction has become an integral part of breast cancer care. However, superior alternatives to the current methods of implant breast reconstruction are required, both to improve patient outcomes and to relieve the economic burden of repeated operations required with implant reconstruction.

What are some of the biggest challenges you face as a researcher in your field?

As this treatment will be utilised by patients who will have undergone a mastectomy for the treatment of breast cancer, assessment of the oncological safety of this strategy will be of paramount importance.

The harvesting and reimplantation of cells from breast cancer patients for breast regeneration purposes must not increase the risk of breast cancer recurrence.

Secondly, the generation and maintenance of adequate volumes of adipose tissue to recreate the breast mound is a major challenge due to resorption of implanted cells by the body, and by the challenges in creating an adequate blood supply for the engineered tissue graft.

What are some of the areas of research you’d like to see tackled in the years ahead?

I would like to see the integration of scaffold biomaterials into drug delivery methods in surgical oncology.

This would aid in the reduction of side effects of therapies that are currently delivered systemically to patients, eg in the form of oral or IV drugs, therefore improving patient compliance with therapies and potentially reducing the cost of delivering these treatments to an ever-increasing population.

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