The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review

Abstract

We read with great interest the article entitled “The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review” by Faulkner et al.,1 which aimed to evaluate the advantages of using Vicryl mesh in single-stage direct-to-implant breast reconstruction. The authors presented a retrospective review of 227 patients who underwent implant-based breast reconstruction with absorbable mesh as a safe alternative to acellular dermal matrix. Although other articles in the literature have studied absorbable mesh in breast reconstructive surgery,2,3 this article was the largest long-term study to date on the use of Vicryl mesh in prosthetic breast reconstruction. We compliment the authors on their excellent efforts in this respect, and would also like to express some considerations regarding this article. First, the authors compared the incidence of postoperative complications for prosthesis breast reconstruction using an absorbable mesh with that for acellular dermal matrix–assisted breast reconstruction; they concluded that the incidence of complications was lower when using absorbable mesh. However, the authors did not specify a specific follow-up time, and we believe that it is best to compare the incidence of complications in reconstruction with or without absorbable mesh to make the results more convincing. In addition, according to the authors’ description, a half piece of Vicryl mesh was used for one breast, for patients with unilateral breast reconstruction after mastectomy. The remaining half of the Vicryl mesh could be wasted. We think that two pieces of the mesh could be utilized, one inferior for support and one lateral for further strengthening, both to avoid the waste and to ensure the further stability of the pocket. Also, according to published literature, Vicryl mesh is absorbed 3 to 4 weeks after implantation, thus losing its function as a supporting structure and leading to insufficient blood supply to the lower part of the flap, which may lead to complications such as flap ischemia.4 Therefore, we suggest that further studies on the blood flow of the flap be conducted to determine the relationship between the use of absorbable mesh and flap ischemia. By the way, there is an error in this article. In the fifth line in the first paragraph of the Results section, the text states that bilateral cases were performed in 146 patients, but 146 patients should have accounted for 64.3 percent, instead of the 65.6 percent in the article. We are very grateful to the authors for carrying out this study, which has brought us to the understanding that synthetic absorbable mesh can be a reasonable alternative to acellular dermal matrix in prosthetic breast reconstruction, which has the characteristics of safety and economy. We also hope to see the progress of their research on the use of Vicryl mesh in prepectoral prosthetic breast reconstruction soon. DISCLOSURE Neither author has a financial interest to declare in relation to the content of this communication. Haoran Li, M.M.Dali Mu, M.D.Department of Aesthetic and Reconstructive Breast SurgeryPlastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, People’s Republic of China