Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis

Abstract

Background:In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications.However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis. Methods:We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, non-absorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models. Results:Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or non-absorbable types, compared with the non-mesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the non-absorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups. Conclusion:Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

Postoperative Outcomes of Pre-Pectoral Versus Sub-Pectoral Implant Immediate Breast Reconstruction

“…As a result, the use of a mesh has dramatically fallen. In fact, a recent meta-analysis of 17 studies, evaluated complication rates comparing the acellular dermal matrix (ADM), a synthetic absorbable mesh, a synthetic non-absorbable mesh and no matrix [ 75 ]. The infection rate was higher for ADM, the seroma rate was lower for the synthetic absorbable matrix (OR: 0.2) and the synthetic non-absorbable matrix (OR: 0.1 compared to ADM).…”

“…The infection rate was higher for ADM, the seroma rate was lower for the synthetic absorbable matrix (OR: 0.2) and the synthetic non-absorbable matrix (OR: 0.1 compared to ADM). However, clinically significant complications (grade 2 and 3) did not differ between patients who received prepectoral or subpectoral implants [ 75 ]. In the above meta-analysis, major complications were similar whether or not a mesh was used.…”

Surgical and Patient-Reported Outcomes After Mastectomy and Implant-Based Prepectoral Reconstruction Using TIGR® Synthetic Mesh

“…Studies have shown a higher infection rate with the use of ADM compared to synthetic mesh or no mesh after MIBR. A recent systematic review found a 2.97 times higher infection rate with ADM compared to no mesh but no significant difference between synthetic meshes and no mesh use in infection rate [ 9 ]. In another literature review by Ellis et al, infection rates with ADM in the literature ranged between 0.2% and 35.8%, while with synthetic mesh use in breast reconstruction, studies report an infection rate between 1.3% and 6.1% [ 13 ].…”

“…While ADMs are widely used, there is no strong evidence for their superior outcomes compared to synthetic meshes. A recent systematic review found lower infection and seroma rates in synthetic meshes compared to ADMs but no significant difference in re-operation rates and implant removal [ 9 ]. However, there is no strong evidence comparing patient-reported outcomes (PROMs) between synthetic meshes and biologic matrices.…”

Immediate Breast Reconstruction with Implants

“…ADMs have a significant economic burden and can be a deterrent to use while the relative cost-effectiveness of synthetic meshes makes it an appealing alternative option [48]. Meshes are also associated with less frequent infections and seroma formation in comparison with ADMs [49]. It is important to understand that though offering similar support, synthetic meshes do not provide additional soft tissue coverage, which ADMs can provide, and caution should be exercised with thin mastectomy skin flaps.…”