NHS surgeons use high-tech 3D printers to make replacement ribs for patients who have had part of their chest wall removed to cut out cancerous tumors

Patients recovering from surgery to remove breast and lung tumors can hope to breathe easier thanks to replacement ribs made from high-tech 3D printers.

The implants are given to people who have had part of their chest wall removed during treatment and are made with scans of the chest, which are formed layer by layer in the printer to perfectly match the bones being formed.

Traditional techniques for closing chest holes that give the surgeon access to areas of cancer do not always fit the anatomy well and can make breathing difficult.

According to studies, the same problem is not observed in patients who underwent the new method.

“If the opening is small, we sometimes seal it with surgical gauze,” says Andrea Bille, consultant thoracic surgeon at Guy’s and St Thomas NHS Foundation Trust in London. “But for large gaps, surgeons typically make a concrete implant that fills all the empty space, with no gaps between the ribs.

Pioneering work is being done by Guy’s and St Thomas’ NHS Foundation Trust in London (pictured).

“Often the way the cement sets leaves too little room for the chest to expand while you breathe. This meant that the patients suffered from breast swelling and could not exercise.

“Thanks to the new technology, the implant is perfectly adapted to the person.”

Around 48,000 Britons are diagnosed with lung cancer each year. About half of lung cancer cases are diagnosed when the disease has already spread, usually to nearby breast tissue.

While some of these tumors can be destroyed with radiation therapy alone, many tumors require surgery to remove them. In up to one in ten cases, the surgeon will need to remove at least part of the chest to gain access to cancerous tissue.

Since 2018, some NHS surgeons have been using 3D printing technology to create custom implants from layers of titanium powder to replace these parts of the ribs. But titanium is not an ideal material, explains Mr. Bille: “It doesn’t fit well with the shape of the body and the metal is attached with screws, which can be painful.”

Scientists at King’s College London have developed replacement ribs from smaller, strategically placed pieces of concrete, which are offered to a small number of patients with advanced lung cancer or rare soft tissue tumors – called sarcomas – in the chest.

While a titanium implant is pressed externally and can take several weeks to complete, the new replacement can be made in as little as 48 hours. Titanium implants also cost around £1,000 per patient, while the new ones are just £40.

For the new technique, surgeons take detailed CT scans of the area. The images, along with key patient information such as age, height and weight, are fed into a sophisticated computer program that creates an exact replica of the patient’s breast. This is sent to the 3D printer, which creates a mold of each individual rib. It is then filled with concrete to create the implant.

About a day later, the patient comes for the operation. Surgeons remove the area of ​​the bone needed to access the tumor, along with the cancerous tissue. They then attach the implant to the remaining bone with strong sutures before closing the incision.

“Patients usually recover much faster than with previous implants,” says Bille. “You can start training again in a few weeks instead of a few months.”

One patient who will benefit from the new technique is 75-year-old Colin Rose, from Kent, who underwent the procedure as part of a 2019 study after doctors found sarcoma cancer in his chest wall.

Surgeons removed three ribs and part of his sternum to remove all the cancer and make sure it had not spread.

All three ribs were replaced with the 3D printing process.

Colin has remained cancer free ever since. “My spare ribs don’t give me any problems,” he said. “I asked my surgeon how long the ribs would last – and he jokingly said about 200 years. But they feel very sturdy.’