Three-Dimensional Bioprinting in Reconstructive Plastic Surgery: A Comprehensive Review

Abstract

Three-dimensional (3D) bioprinting is an evolving biofabrication approach in regenerative medicine with the potential to overcome many limitations of conventional reconstructive techniques, including donor-site morbidity, limited tissue availability, and suboptimal restoration of form and function. Recent advances in biofabrication have accelerated the development of patient-specific living constructs for reconstructive applications. This narrative review synthesizes contemporary evidence on the use of 3D bioprinting in reconstructive surgery, emphasizing developments most relevant to plastic surgery. The current literature on bioprinting technologies, bioinks, tissue-specific applications, translational studies, and regulatory considerations was critically reviewed. Significant progress has been achieved in the bioprinting of skin, cartilage, bone, osteochondral tissues, vascularized constructs, and composite craniofacial tissues. Advances in extrusion-, inkjet-, laser-, and stereolithography-based printing, together with increasingly sophisticated natural and synthetic bioinks, have improved construct fidelity, cellular viability, and tissue-specific functionality. In situ bioprinting, patient-specific computer-aided design, and hybrid biomaterial strategies have further expanded the clinical potential of bioprinted tissues. Despite these advances, major barriers remain, including inadequate vascularization of large constructs, limited mechanical maturation of load-bearing tissues, manufacturing standardization, regulatory uncertainty, and the absence of robust long-term clinical outcomes. Three-dimensional bioprinting is enabling increasingly personalized tissue fabrication, although most applications remain preclinical. Clinical translation will require further advances in biomaterials, vascular engineering, manufacturing standardization, and regulatory science.