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Conventional in vitro models often fail to replicate these features due to mass transport limitations in non\u2010perfused systems. Here, we present a next\u2010generation tumor\u2010on\u2010a\u2010chip platform engineered via high\u2010resolution projection micro\u2010stereolithography (P\u00b5SL) to sustain exceptionally high\u2010density breast cancer tissues (up to 400 million cells\/mL) under continuous perfusion. By integrating a vascular\u2010inspired perfusion architecture with precision\u2010engineered micropores (\u223c7\u00a0\u00b5m), our system enhances nutrient and drug transport compared with traditional non\u2010perfused 3D cultures. This high\u2010density microenvironment drives density\u2010dependent molecular reprogramming of ER\u03b1, Ki67, and CTSL2, closely mirroring the gene expression signatures observed in high\u2010grade patient tumors. Notably, the drug resistance to Elacestrant observed in our high\u2010density tissues uniquely aligns with clinically reported Cmax concentrations, effectively bridging the gap between in vitro screening and in vivo outcomes. This platform provides a physiologically relevant tool for studying aggressive tumor biology and evaluating personalized therapeutic strategies with high predictive power.<\/jats:p>","DOI":"10.1002\/adhm.71457","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:31:45Z","timestamp":1785472305000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A 3D\u2010Printed Vascular\u2010Like Perfusion Tumor\u2010on\u2010a\u2010Chip Recapitulates High\u2010Grade Breast Cancer With in Vivo\u2010Relevant Drug Resistance"],"prefix":"10.1002","volume":"15","author":[{"given":"Geonhui","family":"Lee","sequence":"first","affiliation":[{"name":"BMF Precision Inc.  Maynard Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingjie","family":"Sun","sequence":"additional","affiliation":[{"name":"BMF Precision Inc.  Maynard Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5713-629X","authenticated-orcid":false,"given":"Nicholas X.","family":"Fang","sequence":"additional","affiliation":[{"name":"BMF Precision Inc.  Maynard Massachusetts USA"},{"name":"The University of Hong Kong  Hong Kong China"},{"name":"Materials Innovation Institute for Life Sciences and Energy (MILES) HKU\u2010SIRI  Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9079-2665","authenticated-orcid":false,"given":"Chunguang","family":"Xia","sequence":"additional","affiliation":[{"name":"BMF Precision Inc.  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