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

Having an ice pack strapped to your chest – that’s how some describe the experience of taking a walk in cold weather when you have breast implants. Silicone only slowly reaches body temperature once out of the cold, so that icy feeling can persist for hours. As well as being uncomfortable, for breast cancer survivors it can be an unwelcome reminder of a disease they would rather put behind them.

Every year, 2 million people worldwide are diagnosed with breast cancer and the treatment often involves removing at least one breast. But most choose not to have their breasts reconstructed; in the UK, it is only about 30%. Now a handful of startups want to change that, armed with 3D-printed implants that grow new breast tissue before breaking down without a trace. “The whole implant is fully degradable,” says Julien Payen, CEO of the startup Lattice Medical, “so after 18 months you don’t have any product in your body.”

It could spell the end not only of cold breasts, but the high complication rates and long surgeries associated with conventional breast reconstruction. The first human trial of such an implant, Lattice Medical’s Mattisse implant, is scheduled to begin on 11 July in Georgia. Others will soon follow. “We expect to start clinical trials in two years’ time,” says Sophie Brac de la Perrière, CEO of another startup, Healshape.

“It’s exciting,” says Stephanie Willerth, professor of biomedical engineering at the University of Victoria, Canada, who is not involved with the companies. “As engineers, we’ve been playing with 3D printing for half a decade”, but having a clinical use that doctors recognise as useful for patients is key to getting the technology out there, she says.

But in a field fraught with difficult medical compromises, unequal access issues and expectations about what women want, the question is how big an impact the new technology will actually have.


Today, there are two main types of breast reconstruction: silicone implants and flap surgery. While implants are easy to install, flap surgery is a highly specialised business that requires a tissue “flap” being taken from the stomach, thigh or back. Surgeons often recommend flaps because, while there’s a lot of initial surgery and a longer recovery period, it gives a good, long-lasting result.

Silicone is still the most common choice. It is easy and simple, which appeals to cancer patients who either medically can’t have or mentally can’t face having tissue removed from another part of their body. But “it’s far from perfect”, says Shelley Potter, an oncoplastic surgeon at the University of Bristol and the Bristol Breast Care Centre. “It’s quite high risk. There’s a 10% chance of losing an implant.”

Healshape’s 3D-printed hydrogel implant
Healshape’s 3D-printed hydrogel implant, designed to be colonised by the patient’s fat cells over six to nine months. The company hopes to start trials in two years’ time. Photograph: Healshape

Silicone implants also require replacement every 10 or so years and they have had their fair share of scandals: the 2010s PIP scandal, in which a major implant manufacturer was found to have made its implants of dodgy silicone, and the 2018 Allergan scandal, in which popular textured implants were linked to an increased risk of a rare lymphoma. And as an American study from last year shows, it is mainly the idea of having that foreign object stuck inside your body that puts many off reconstruction altogether.

“So what we want to do,” says Brac de la Perrière, “is to give the benefits of the different solutions without the constraints.” In other words: the single, simple surgery of an implant, but without any lingering foreign material to cause trouble.

This can be achieved in different ways. Healshape uses a hydrogel to 3D-print a soft implant that will slowly be colonised by the person’s own fat cells, the initial batch of which is injected, while the implant disappears over six to nine months. The company CollPlant is developing something similar using a special collagen bioink, extracted from tobacco leaves it has genetically engineered to produce human collagen. “I think it will change the opinion of many patients,” says CEO, Yehiel Tal.

Lattice Medical has a different approach. Its implant is a 3D-printed cage made of a degradable biopolymer, in which they encase a small flap from underneath the breast area. This flap then grows to fill the cage with fat tissue, while the cage itself is absorbed by the body, ultimately leaving a regrown breast in its place.

Lattice Medical’s Mattisse implant
Lattice Medical’s Mattisse implant. Vascular adipose tissue is inserted into a bio-resorbable ‘tissue engineering chamber’, which degrades over 18 months. Trials are imminent. Photograph: Lattice Medical

Regrowing breasts using a cage has been shown to work in humans before, in a 2016 trial. However, it only worked in one of five women and the cages were not degradable. Andrea O’Connor from the University of Melbourne, Australia, who led the trial’s engineering team, hopes the new trial will address the problems raised in the first – for example, that patient responses can vary greatly. But if successful, it “would have the potential to help many women to achieve a superior reconstruction”, she says. Lattice Medical says its cage is an improvement because a flat base and larger pores help the tissue grow.

One big unknown is how much feeling the regrown breasts will have. A mastectomy usually means losing some sensation and, according to plastic surgeon Stefania Tuinder from the Maastricht University Medical Centre+ in the Netherlands, reconstruction affects it too. “From our data, it seems that implants have a negative effect on sensation, so the feeling in the skin is less than when you have only a mastectomy,” she says. In comparison, reconstruction from a flap with connected nerves can bring back some feeling within a few years.

Tuinder suspects the implant numbness is both because of nerve damage when the implants are inserted, and because the nerves can’t grow back once they are blocked by a lump of silicone. Whether that will also apply to the new implants remains to be seen, but since eventually there will be nothing to block the nerves, hopes are that sensation will be better.


Tissue engineered implants, however, are not the only recent innovations in the field. Many groups are working on perfecting a reconstruction technique using injections of the person’s own fat, boosted with extra stem cells to help the tissue survive. Medical professionals are still debating the safety and how the breasts hold up long term. In contrast to the new implants, the procedure might have to be done several times.

While any of these new techniques could result in something better than what’s currently on offer, Potter warns that we have a tendency to jump at new and shiny tech – an optimism bias. “We always think it’s going to be brilliant,” she says, but “we don’t want a situation like with vaginal mesh, where in 10 years’ time … we find out we have done something that isn’t helpful.”

Other solutions to the problems of reconstruction do exist. One is living without breasts, known as “going flat”. Contrary to the companies that think they can turn the reconstruction statistics around, people within the flat movement argue that if people were better informed, even more would opt out. “I reckon if [going flat] was given as an equal option,” says Gilly Cant, founder of the charity Flat Friends, “at least another 30-50% of women wouldn’t have [reconstruction].”

A Healshape scientist using software to determine the shape of an implant prior to 3D printing. The implants can be custom-made to suit the patient.
A Healshape scientist using software to determine the shape of an implant prior to 3D printing. The implants can be custom-made to suit the patient. Photograph: Healshape

At the moment, the guidance from the National Institute for Health and Care Excellence (Nice) says that doctors should be aware that some might not want reconstruction. But Cant says it is often presented to people as part of the treatment process. “It’s like, ‘OK, we need to do a mastectomy. Then you have chemo. Then you’ll have your radiotherapy and then we’ll do reconstruction.’ So women live for that reconstruction at the end,” she says. It comes to signal the finish line.

It is particularly contentious when only one breast is removed, because some might want the other taken off to feel and look symmetrical, rather than have a new one made. But according to Cant, many doctors don’t want to remove a healthy breast. Part of the doctors’ concern is that women will regret their decision, says Potter, but “women know what they want to do with their own bodies. We should help and support them to do what they want to do.”

Potter herself would like to see more of the ultimate alternative: not having a mastectomy in the first place. “There’s no evidence that mastectomy gives you better cancer outcomes than a breast-conserving operation,” she says. In this case, the tumour is removed but the breast is kept. For example, one of her patients had a breast reduction that removed her cancer while giving her breasts a lift. “She calls them her silver lining breasts.”


So even without tissue-engineered implants, there are enough options to make the choice a hard one. To help people choose, some charities pair up people considering a specific procedure with someone who has already been through it. At the charity Keeping Abreast, show and tell sessions give people the chance to ask the questions they might be uncomfortable asking their doctor and see the results for themselves.

But according to a 2018 report by the all-party parliamentary group on breast cancer, knowing what you want is not the same as having access to it. “There’s a massive postcode lottery,” says Potter. It stems from flap surgery being so involved that it often requires specialist 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, in practice it limits access.

The companies say this won’t be a problem with the new implants, because they are specifically designed to be easy to put in. Flap surgery can take from three to 12 hours depending on the flap, but insertion of Lattice Medical’s implant, for example, takes only one hour and 15 minutes. “It’s really accessible to all plastic surgeons,” says Payen.

This accessibility will no doubt be crucial in taking the new implants from a cool technology to something with real impact. But from Potter’s perspective, it’s just one potential piece in a big puzzle, not a techno-fix. The implants “would be an option for a lot of women”, she says. “But I think the main advance is all around access, proper information, giving women choice and hopefully reducing the number of mastectomies that we need.”

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Culture

Top 10 Florida Cities Dominate The Business Startup Landscape In The U.S.

Top 10 Florida Cities And Business Startup Landscape In The U.S.

The Voice Of EU | Florida emerges as a hub for entrepreneurial endeavors, with its vibrant business landscape and conducive environment for startups. Renowned for its low corporate tax rates and a high concentration of investors, the Sunshine State beckons aspiring entrepreneurs seeking fertile grounds to launch and grow their businesses.

In a recent report by WalletHub, Florida cities dominate the list of the top 10 best destinations for business startups, showcasing their resilience and economic vitality amidst challenging times.

From Orlando’s thriving market to Miami’s dynamic ecosystem, each city offers unique advantages and opportunities for entrepreneurial success. Let’s delve into the chronologically listed cities that exemplify Florida’s prominence in the business startup arena.

1. Orlando Leads the Way: Orlando emerges as the most attractive market in the U.S. for business startups, with a remarkable surge in small business establishments. WalletHub’s latest report highlights Orlando’s robust ecosystem, fostering the survival and growth of startups, buoyed by a high concentration of investors per capita.

2. Tampa Takes Second Place: Securing the second spot among large cities for business startups, Tampa boasts a favorable business environment attributed to its low corporate tax rates. The city’s ample investor presence further fortifies startups, providing essential resources for navigating the initial years of business operations.

3. Charlotte’s Diverse Industries: Claiming the third position, Charlotte stands out for its diverse industrial landscape and exceptionally low corporate taxes, enticing companies to reinvest capital. This conducive environment propels entrepreneurial endeavors, contributing to sustained economic growth.

4. Jacksonville’s Rising Profile: Jacksonville emerges as a promising destination for startups, bolstered by its favorable business climate. The city’s strategic positioning fosters entrepreneurial ventures, attracting aspiring business owners seeking growth opportunities.

5. Miami’s Entrepreneurial Hub: Miami solidifies its position as a thriving entrepreneurial hub, attracting businesses with its dynamic ecosystem and strategic location. The city’s vibrant startup culture and supportive infrastructure make it an appealing destination for ventures of all sizes.

6. Atlanta’s Economic Momentum: Atlanta’s ascent in the business startup landscape underscores its economic momentum and favorable business conditions. The city’s strategic advantages and conducive policies provide a fertile ground for entrepreneurial ventures to flourish.

7. Fort Worth’s Business-Friendly Environment: Fort Worth emerges as a prime destination for startups, offering a business-friendly environment characterized by low corporate taxes. The city’s supportive ecosystem and strategic initiatives facilitate the growth and success of new ventures.

8. Austin’s Innovation Hub: Austin cements its status as an innovation hub, attracting startups with its vibrant entrepreneurial community and progressive policies. The city’s robust infrastructure and access to capital foster a conducive environment for business growth and innovation.

9. Durham’s Emerging Entrepreneurship Scene: Durham’s burgeoning entrepreneurship scene positions it as a promising destination for startups, fueled by its supportive ecosystem and strategic initiatives. The city’s collaborative culture and access to resources contribute to the success of new ventures.

10. St. Petersburg’s Thriving Business Community: St. Petersburg rounds off the top 10 with its thriving business community and supportive ecosystem for startups. The city’s strategic advantages and favorable business climate make it an attractive destination for entrepreneurial endeavors.

Despite unprecedented challenges posed by the COVID-19 pandemic, the Great Resignation, and high inflation, these top Florida cities remain resilient and well-equipped to overcome obstacles, offering promising opportunities for business owners and entrepreneurs alike.


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European Startup Ecosystems Awash With Gulf Investment – Here Are Some Of The Top Investors

European Startup Ecosystem Getting Flooded With Gulf Investments

The Voice Of EU | In recent years, European entrepreneurs seeking capital infusion have widened their horizons beyond the traditional American investors, increasingly turning their gaze towards the lucrative investment landscape of the Gulf region. With substantial capital reservoirs nestled within sovereign wealth funds and corporate venture capital entities, Gulf nations have emerged as compelling investors for European startups and scaleups.

According to comprehensive data from Dealroom, the influx of investment from Gulf countries into European startups soared to a staggering $3 billion in 2023, marking a remarkable 5x surge from the $627 million recorded in 2018.

This substantial injection of capital, accounting for approximately 5% of the total funding raised in the region, underscores the growing prominence of Gulf investors in European markets.

Particularly noteworthy is the significant support extended to growth-stage companies, with over two-thirds of Gulf investments in 2023 being directed towards funding rounds exceeding $100 million. This influx of capital provides a welcome boost to European companies grappling with the challenge of securing well-capitalized investors locally.

Delving deeper into the landscape, Sifted has identified the most active Gulf investors in European startups over the past two years.

Leading the pack is Aramco Ventures, headquartered in Dhahran, Saudi Arabia. Bolstered by a substantial commitment, Aramco Ventures boasts a $1.5 billion sustainability fund, alongside an additional $4 billion allocated to its venture capital arm, positioning it as a formidable player with a total investment capacity of $7 billion by 2027. With a notable presence in 17 funding rounds, Aramco Ventures has strategically invested in ventures such as Carbon Clean Solutions and ANYbotics, aligning with its focus on businesses that offer strategic value.

Following closely is Mubadala Capital, headquartered in Abu Dhabi, UAE, with an impressive tally of 13 investments in European startups over the past two years. Backed by the sovereign wealth fund Mubadala Investment Company, Mubadala Capital’s diverse investment portfolio spans private equity, venture capital, and alternative solutions. Notable investments include Klarna, TIER, and Juni, reflecting its global investment strategy across various sectors.

Ventura Capital, based in Dubai, UAE, secured its position as a key player with nine investments in European startups. With a presence in Dubai, London, and Tokyo, Ventura Capital boasts an international network of limited partners and a sector-agnostic investment approach, contributing to its noteworthy investments in companies such as Coursera and Spotify.

Qatar Investment Authority, headquartered in Doha, Qatar, has made significant inroads into the European startup ecosystem with six notable investments. As the sovereign wealth fund of Qatar, QIA’s diversified portfolio spans private and public equity, infrastructure, and real estate, with strategic investments in tech startups across healthcare, consumer, and industrial sectors.

MetaVision Dubai, a newcomer to the scene, has swiftly garnered attention with six investments in European startups. Focusing on seed to Series A startups in the metaverse and Web3 space, MetaVision raised an undisclosed fund in 2022, affirming its commitment to emerging technologies and innovative ventures.

Investcorp, headquartered in Manama, Bahrain, has solidified its presence with six investments in European startups. With a focus on mid-sized B2B businesses, Investcorp’s diverse investment strategies encompass private equity, real estate, infrastructure, and credit management, contributing to its notable investments in companies such as Terra Quantum and TruKKer.

Chimera Capital, based in Abu Dhabi, UAE, rounds off the list with four strategic investments in European startups. As part of a prominent business conglomerate, Chimera Capital leverages its global reach and sector-agnostic approach to drive investments in ventures such as CMR Surgical and Neat Burger.

In conclusion, the burgeoning influx of capital from Gulf investors into European startups underscores the region’s growing appeal as a vibrant hub for innovation and entrepreneurship. With key players such as Aramco Ventures, Mubadala Capital, and Ventura Capital leading the charge, European startups are poised to benefit from the strategic investments and partnerships forged with Gulf investors, propelling them towards sustained growth and success in the global market landscape.


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China Reveals Lunar Mission: Sending ‘Taikonauts’ To The Moon From 2030 Onwards

China Reveals Lunar Mission

The Voice Of EU | In a bold stride towards lunar exploration, the Chinese Space Agency has unveiled its ambitious plans for a moon landing set to unfold in the 2030s. While exact timelines remain uncertain, this endeavor signals a potential resurgence of the historic space race reminiscent of the 1960s rivalry between the United States and the USSR.

China’s recent strides in lunar exploration include the deployment of three devices on the moon’s surface, coupled with the successful launch of the Queqiao-2 satellite. This satellite serves as a crucial communication link, bolstering connectivity between Earth and forthcoming missions to the moon’s far side and south pole.

Unlike the secretive approach of the Soviet Union in the past, China’s strategy leans towards transparency, albeit with a hint of mystery surrounding the finer details. Recent revelations showcase the naming and models of lunar spacecraft, steeped in cultural significance. The Mengzhou, translating to “dream ship,” will ferry three astronauts to and from the moon, while the Lanyue, meaning “embrace the moon,” will descend to the lunar surface.

Drawing inspiration from both Russian and American precedents, China’s lunar endeavor presents a novel approach. Unlike its predecessors, China will employ separate launches for the manned module and lunar lander due to the absence of colossal space shuttles. This modular approach bears semblance to SpaceX’s Falcon Heavy, reflecting a contemporary adaptation of past achievements.

Upon reaching lunar orbit, astronauts, known as “taikonauts” in Chinese, will rendezvous with the lunar lander, reminiscent of the Apollo program’s maneuvers. However, distinct engineering choices mark China’s departure from traditional lunar landing methods.

The Chinese lunar lander, while reminiscent of the Apollo Lunar Module, introduces novel features such as a single set of engines and potential reusability and advance technology. Unlike past missions where lunar modules were discarded, China’s design hints at the possibility of refueling and reuse, opening avenues for sustained lunar exploration.

China Reveals Lunar Mission: Sending 'Taikonauts' To The Moon From 2030 Onwards
A re-creation of the two Chinese spacecraft that will put ‘taikonauts’ on the moon.CSM

Despite these advancements, experts have flagged potential weaknesses, particularly regarding engine protection during landing. Nevertheless, China’s lunar aspirations remain steadfast, with plans for extensive testing and site selection underway.

Beyond planting flags and collecting rocks, China envisions establishing a permanent lunar base, the International Lunar Research Station (ILRS), ushering in a new era of international collaboration in space exploration.

While the Artemis agreements spearheaded by NASA have garnered global support, China’s lunar ambitions stand as a formidable contender in shaping the future of space exploration. In conclusion, China’s unveiling of its lunar ambitions not only marks a significant milestone in space exploration but also sets the stage for a new chapter in the ongoing saga of humanity’s quest for the cosmos. As nations vie for supremacy in space, collaboration and innovation emerge as the cornerstones of future lunar endeavors.


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