Mesh In Breast Reconstruction Research Articles

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

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, nonabsorbable 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 nonabsorbable types, compared with the nonmesh 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 nonabsorbable 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.

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

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

Research Progress of Titanium Polypropylene Mesh in Breast Reconstruction

To investigate the application of titanium polypropylene mesh in breast reconstruction. In this study, we selected the literature data in recent 4 years to analyze the application of titanium polypropylene mesh in breast reconstruction. Using the keywords of “breast reconstruction,” “titanium polypropylene mesh,” “application” and “research progress,” we analyzed and summarized the related research progress of titanium polypropylene mesh in breast reconstruction. The research was conducted using the analysis of titanium polypropylene mesh, titanium polypropylene mesh in breast reconstruction surgery advantages, adverse complications related to titanium polypropylene mesh in breast reconstruction surgery and preventive measures. By constantly improving these aspects in the research process, the current study has certain value, and may guide the research work of titanium mesh in breast reconstruction.

Biological and synthetic mesh assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons

These guidelines have been produced with the involvement of the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. Recommendations have been derived after a review of published data regarding the use of acellular dermal matrix (ADM), biological and synthetic mesh in breast reconstruction. The guidelines represent a consensus opinion on the optimal management of patients having biological or synthetic mesh assisted breast reconstruction informed by peer-review publications. The Guidelines should be used to inform clinical decision making. Ultimately, members of the MDT remain responsible for the treatment of patients under their care.

TIGR® Matrix Mesh in breast reconstruction – A single unit experience

TIGR® Matrix Mesh in breast reconstruction – A single unit experience

Subcutaneous Tissue Expander Placement with Synthetic Titanium-Coated Mesh in Breast Reconstruction

A subcutaneous, prepectoral, muscle-sparing approach has been recently described for implant-based breast reconstruction. This is a preliminary series of 2-stage breast reconstructions by means of tissue expander placed subcutaneously with the support of a titanium-coated polypropylene mesh. A pilot series of cases was started in 2012. Inclusion criteria were informed consent, age less than 80 years, normal body mass index (range, 18.5-24.9), no T4 and metastatic cancers, no comorbidities, and nonsmoking patients. Expander losses, infections, seromas, skin/nipple necrosis, wound dehiscence, and reinterventions were registered in follow-up visits. Furthermore, patients were followed up in second-stage procedures and for at least 1 year from implant positioning to collect any surgical complication, reinterventions, cosmetic outcome, and oncological data. Between June 2012 and March 2014, 25 cases were enrolled in the study. Expander/implant loss rate was 0%. Skin/nipple necrosis rate was 4%. Infections rate was 12% after first-stage and 4% after second-stage procedure. Seromas rate was 0%. Five (20%) fat graft procedures were performed over the expander before second-stage reconstruction, and no reinterventions were required after second stage. Patients mean score was 99 for cosmetic outcome satisfaction, in a 0-100 scale. Subcutaneous 2-stage reconstruction with synthetic mesh proved safe and feasible. Patients satisfaction is very good after 14 months median follow-up form definitive implant placement. Although the present study involved only a small number of cases, a tissue-expander subcutaneous reconstruction seems to have promising results. Whenever pectoralis major muscle can be spared, a conservative reconstruction might be an option.

Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review

Mastectomy and breast reconstruction are essential parts of the treatment of breast cancer. Acellular dermal matrices (ADMs) have been used for the reconstruction of the lower pole due to many advantages; however, its cost is seen as a major drawback in this era of concern for the allocation of health-care funds. Recently, polyglactin 910 (Vicryl; Ethicon, Somerville, NJ, USA) mesh has been published as an alternative. We assessed the published literature, in particular investigating for studies that compare Vicryl mesh with ADM. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searched databases included Medline/PubMed, Cochrane Reviews, Embase, Web of Science, ClinicalTrials, and SCOPUS. Search criteria were as follows: (1) reporting of clinical data using Vicryl mesh in breast reconstruction, (2) reporting of original data, and (3) outcome of interest reported. We retrieved 290 de-duplicated articles. After title and abstract screening, we dismissed 258 articles, and thus full text was reviewed for 32 articles; only three retrospective articles met inclusion criteria. The total population included 112 patients and 156 breasts. The reported incidence of complications was as follows: infection 2.6% (confidence interval (CI): 0.7-6.6%), reconstruction failure 3.2% (CI: 1.0-7%), and seroma 1.3% (CI: 0.2-4.6%). A seven- to 12-fold cost difference was reported. Follow-up length ranged from 1.2 to 3.6 years. No studies directly compared Vicryl mesh with ADM. Although the evidence is limited, polyglactin 910 (Vicryl) mesh for immediate breast reconstruction appears to be a potentially safe, effective, and less expensive alternative to ADM. Prospective studies are needed to further compare mesh with ADM.

Autoderm

The widespread use of bioprosthetic mesh in breast reconstruction has revealed an increased risk of seroma and infection, and a high financial cost. This study introduces a technique that mitigates these shortcomings using an autologous dermal graft (Autoderm). Indications, operative technique, and 1-year outcomes are reviewed. Thirty-six breasts in 21 patients underwent six unilateral and 15 bilateral, implant-based breast reconstructions with Autoderm. Mean follow-up was 365 days (range, 273 to 575 days). The overall complication rate was 13.9 percent. No patients developed breast cellulitis, hyperemia, periprosthetic infection, or seroma. There was one implant exposure following expansion. Autoderm provides the advantages of lower pole support and breast shaping, without the disadvantages of increased infection, seroma, and the high cost associated with allograft and xenograft meshes.

Empleo de mallas biológicas en la reconstrucción inmediata posmastectomía. Primeros resultados y consideraciones

ObjectiveThis study describes the use of biological mesh in breast reconstruction and its results. Patients and methodsA study was conducted on 40 consecutive patients with mastectomy and immediate reconstruction with biological mesh and implants. The indication was breast cancer in 29 cases, and prophylactic in 11 patients. Neoadjuvant treatment was administered to 12 patients. ResultsThere were 8 skin necrosis, 8 perigraft seroma, 5 haematomas, 3 abscesses, 2 with pain and 1 extrusion. Twelve patients underwent surgery (30%) with removal of the mesh and implant /expander in 8 cases (20%). The mesh and the implant had to be removed in all cases were there had been conservative surgery followed by radiotherapy. ConclusionsRadiotherapy and implant volume are important factors for failed reconstruction.

514 Volume Replacement with Polyglactin 910 Mesh for Breast Reconstruction After Endoscopy-assisted Breat Conserving Surgery for Treating Early Breast Cancer – the Early Results

mesh made with Polyglactin 910 for breast reconstruction after performing endoscopy-assisted breast conserving surgery. Methods: From July 2006 to July 2008, we performed endoscopiy-assisted breast surgery in 30 patients with early breast cancer. (Thirty [fourteen] patients [who] underwent endoscopy-assisted breast conserving surgery). Of the total patients, 14 underwent reconstruction procedure (volume replacement with the use of a Vicryl mesh) and 16 underwent reconstuction without Vicryl mesh. We were evaluated for their quality of life (QOL), the surgery-related complications and the cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to a positive resection margin. Results: The median age of the patient was 49.4 year (range 36-60 year) and all of the patients had a diagnosis of early breast cancer (less than stage IIb). In general, the patients were satisfied with the outcome for their QOL. The patients were especially satisfied with the cosmetic outcome. The patients’ satisfaction increased with longer follow-up, as compared to that for the shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within a collection of tissue fluid, as seen on ultrasonography. At 20 months after surgery, the skin and breast shape both recovered. Conclusion: The results of this study showed that for relatively short followup period, breast reconstruction with using Polyglactin 910 mesh, which is made from oxidized regenerated cellulose, resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.

Attitudes toward Biological Mesh in Breast Reconstruction: A Regional Survey of Plastic Surgeons

Attitudes toward Biological Mesh in Breast Reconstruction: A Regional Survey of Plastic Surgeons

0108 Early result: Volume replacement with Polyglatin910 mesh for breast reconstruction after endoscopic breast conservative surgery of early breast cancer

0108 Early result: Volume replacement with Polyglatin910 mesh for breast reconstruction after endoscopic breast conservative surgery of early breast cancer

Volume Replacement with Polyglactin 910 Mesh for Breast Reconstruction after Endoscopy-Assisted Breast Conserving Surgery for Treating Early Breast Cancer: the Early Results

mesh made with Polyglactin 910 for breast reconstruction after performing endoscopy-assisted breast conserving surgery. Methods: From July 2006 to July 2008, we performed endoscopiy-assisted breast surgery in 30 patients with early breast cancer. (Thirty [fourteen] patients [who] underwent endoscopy-assisted breast conserving surgery). Of the total patients, 14 underwent reconstruction procedure (volume replacement with the use of a Vicryl mesh) and 16 underwent reconstuction without Vicryl mesh. We were evaluated for their quality of life (QOL), the surgery-related complications and the cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to a positive resection margin. Results: The median age of the patient was 49.4 year (range 36-60 year) and all of the patients had a diagnosis of early breast cancer (less than stage IIb). In general, the patients were satisfied with the outcome for their QOL. The patients were especially satisfied with the cosmetic outcome. The patients’ satisfaction increased with longer follow-up, as compared to that for the shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within a collection of tissue fluid, as seen on ultrasonography. At 20 months after surgery, the skin and breast shape both recovered. Conclusion: The results of this study showed that for relatively short followup period, breast reconstruction with using Polyglactin 910 mesh, which is made from oxidized regenerated cellulose, resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.