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Synthetic meshes, xenografts, and autologous skin or bowel grafts are hindered by their immunogenicity, poor integration, and non-physiological properties. We report a scalable platform for the fabrication of patient-specific living vaginal grafts from autologous fibroblasts. Using scaffold-free micromolding and automated assembly, fibroblasts from small full-thickness vaginal biopsies self-assembled into a collagen-rich, highly aligned extracellular matrix. To improve mechanical integrity, we create twisted subunit assemblies that displayed highly aligned collagen, dense cellularity, and a predominantly quiescent fibroblast phenotype with minimal myofibroblast activation. This autologous tissue-specific construct addresses the shortcomings of current materials and offers a customizable and biocompatible solution for regenerative gynecology. By combining tissue specificity, immunologic safety, and modular scalability, this approach has the potential to transform surgical options for congenital anomalies, post-oncologic reconstruction, fistula repair, and pelvic organ prolapse.<\/jats:p>","DOI":"10.1088\/1758-5090\/ae8d5c","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T22:50:57Z","timestamp":1784587857000},"page":"035040","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Scalable subunit-based strategy to fabricate autologous vaginal tissue grafts"],"prefix":"10.1088","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9689-3824","authenticated-orcid":true,"given":"Pamela A","family":"Moalli","sequence":"first","affiliation":[{"name":"University of Pittsburgh"},{"name":"Magee-Womens Hospital of the University of Pittsburgh"},{"name":"Magee-Womens Research 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