Synthetic Mesh in Immediate Breast Reconstruction

Abstract

The use of biological matrices in immediate implant-based breast reconstruction arose with the need to reinforce the lower pole of the breast and to cover the implant to reduce the risk of implant exposure. Synthetic mesh appears to be a lower cost alternative to biological matrices. This literature review aims to assess the usefulness of the use of synthetic meshes in breast reconstruction compared with the traditional techniques and whether outcomes and complications of synthetic meshes and biological matrices are comparable. The positioning of the implants and meshes, either submuscular or subcutaneous, has also been considered.

Comparing the Outcomes and Complication Rates of Biologic vs Synthetic Meshes in Implant-Based Breast Reconstruction

“…56,57 In comparison with biologic meshes, which are made of different materials but have largely similar properties, synthetic meshes are more varied in their composition and physical properties. 19 Although this suggests that different synthetic mesh products should be more varied in terms of their outcomes, few studies exist to support this hypothesis.…”

“…The few review articles on this subject focus on biologic meshes and are not exhaustive in their study of mesh products, but they do seem to agree that biologic meshes are largely equivalent in terms of complications 56,57 . In comparison with biologic meshes, which are made of different materials but have largely similar properties, synthetic meshes are more varied in their composition and physical properties 19 . Although this suggests that different synthetic mesh products should be more varied in terms of their outcomes, few studies exist to support this hypothesis.…”

“…17 Approximately 20 of these mesh products are currently used in IBBR, providing a range of physical properties for surgeons to choose from when determining what interposition device to use. 18,19 With respect to breast reconstruction, studies investigating the efficacy of surgical meshes tend to focus on the presence or absence of mesh, where the mesh category being studied is overwhelmingly biologic. Whereas some studies cite no negative impact of ADMs on surgical outcomes, 20,21 others report that ADMs increase complication rates but may reduce rates of capsular contracture and produce better cosmetic outcomes when compared with reconstruction with traditional techniques.…”

“…There are over 45 surgical meshes currently on the market, many of which have been approved for use in hernia repair by the Food and Drug Administration via the 510(k) process 17 . Approximately 20 of these mesh products are currently used in IBBR, providing a range of physical properties for surgeons to choose from when determining what interposition device to use 18,19 . With respect to breast reconstruction, studies investigating the efficacy of surgical meshes tend to focus on the presence or absence of mesh, where the mesh category being studied is overwhelmingly biologic.…”

Main factors determining the use of free MS-TRAM and DIEP flaps and comparing the results of breast reconstruction

“…Autologous breast reconstruction allows for a natural-looking breast with ductility, ptosis, and normal skin temperature, which is difficult to achieve with synthetic materials [ 5 ]. Lower front abdominal wall tissues are the most often used material for breast reconstruction (transverse rectus abdominis myocutaneous, or TRAM-flap) [ 6 ].…”