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Bilateral skin-sparing mastectomies. Immediate reconstruction with Gore-Tex. (a) Preoperation. (b) Postoperation following expander-to-implant exchange.
Source publication
Objective: This study seeks an alternative to acellular dermal matrix in 2-staged breast reconstruction while minimizing cost. It was hypothesized that use of a Gore DualMesh would allow for similar intraoperative tissue expander fill volumes, time to second-stage reconstruction, and number of postoperative fills compared with acellular dermal matr...
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Background: The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related QoL and patient’s...
Background:. Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing imme...
Background:
Implant-based immediate breast reconstruction (IBR) is the most common technique for post-mastectomy reconstructions in the United Kingdom (UK). Subpectoral implant placement is the conventional method of reconstruction. Placement of implant in the subcutaneous pocket covered by an acellular dermal matrix (ADM) is a relatively recent a...
Background:
The majority of two-stage prepectoral breast reconstruction has been described utilizing acellular dermal matrix (ADM). Although reports of prepectoral breast reconstruction without ADM exist, there is a paucity of comparative studies.
Methods:
A single-institution retrospective review was performed of consecutive patients undergoing...
In modern implant-based immediate breast reconstruction, it has become common to use biological acellular dermal and synthetic matrices in combination with a tissue expander or an implant. The aim of this systematic review was to examine differences in recurrence of cancer, impact on oncological treatment, health related quality of life, complicati...
Citations
... Synthetic meshes are a viable, cost-effective alternative to acellular dermal matrices. 4,5 The first account of synthetic mesh (nonabsorbable) being used for implant-based breast reconstruction was in 1997. 6 Vicryl (Johnson & Johnson, New Brunswick, N.J.) mesh is completely absorbable: in vivo at 6 weeks, it is relatively intact with minimal change; absorption is completed between 60 and 90 days. ...
Background:
Breast reconstruction is most frequently performed using implants or expanders. Adjunctive materials such as acellular dermal matrix and synthetic meshes are used to support the implant or expander. A paucity of large studies exist on the use of synthetic mesh for breast reconstruction.
Methods:
A retrospective chart review of all patients over the past 7 years who had implant reconstruction with synthetic absorbable mesh at the Massachusetts General Hospital was performed. Data were collected on demographic and surgical outcomes. Statistical analysis was performed.
Results:
A total of 227 patients (376 mastectomies) were treated with direct-to-implant subpectoral reconstruction with absorbable mesh from 2011 to 2017. The infection rate was 2.1 percent. The rate of capsular contracture was 4.8 percent. Patients who had radiation therapy either preoperatively or postoperatively had a higher rate of complications, including capsular contracture. Cost savings for using mesh instead of acellular dermal matrix surpassed $1.2 million.
Conclusion:
Synthetic absorbable mesh is a safe alternative to acellular dermal matrix in prosthetic breast reconstruction and provides stable results along with significant cost savings.
Clinical question/level of evidence:
Therapeutic, IV.
Background
Bilateral mastectomy for both therapeutic and prophylactic reasons is becoming increasingly important. To achieve good results after mastectomy, synthetic meshes are often used as an alternative to acellular dermal matrices (ADMs). The aim of this study is to analyze the results of subcutaneous mastectomies and direct-to-implant breast reconstruction using SERASYNTHⓇ MESH BR.
Methods
In this work, data from mastectomies (n = 32) in 22 patients without prior radiation after breast reconstruction with SERASYNTHⓇ MESH BR from a single center were retrospectively analyzed with 1 year follow-up. Complications were categorized as serious (need for revision surgery) and minor events. Statistical analysis was performed using the t-test in SPSS. Data were compared with the existing literature.
Results
Major complications occurred in 15.6% (n = 5). Two out of five revisions were due to hematoma. In three cases, a seroma followed by other complications (e.g., infections, necrosis) necessitated revision. Minor complications occurred in 12.5% of cases. Due to the safety aspect, implants were replaced in each revision. There was no significant difference in complication rates between prophylactic and therapeutic mastectomies (p = 0.3815, SE = 0.171). There was no statistically significant difference in esthetic outcomes (p = 0.3846).
Conclusion
The application of the absorbable polymer poly-p-dioxanone SERASYNTHⓇ MESH BR has complication rates comparable to those reported in the existing literature. Careful patient selection is paramount in order to limit the complication rate. SERASYNTHⓇ MESH BR can be considered a safe tool to achieve esthetic results in combination with direct-to-implant breast reconstruction.
Introduction and Aims:
The use of acellular dermal matrices (ADM) and synthetic mesh as part of implant-based breast reconstruction (IBBR) has been widely adopted. Our aims were to investigate the clinical efficacy and safety of the use of human/allograft (HADM), xenograft (XADM) and synthetic mesh as part of IBBR in post-mastectomy patients as compared to previous standard implant reconstruction techniques using only a submuscular pocket for coverage.
Methods:
A systematic search for randomised control trials and observational studies was performed. A frequentist network meta-analysis was conducted using the R packages netmeta and Shiny.
Results:
A total of 31 studies of 2375 identified met the predefined inclusion criteria. Traditional submuscular placement (no ADM/mesh) had fewer overall complications compared to HADM (odds ratio [OR] 0.51; Credible interval [CrI]: 0.34 – 0.74), however there was no significant difference between no ADM/mesh and XADM (OR 0.63; CrI: 0.29-1.32) or synthetic mesh (OR 0.77; CrI: 0.44 – 1.30). No one treatment was superior with regards to implant loss. No ADM/mesh was associated with less infectious complications than HADM (OR 0.6; CrI 0.39 – 0.89). Both no ADM/mesh (OR 0.45; CrI 0.27 – 0.75) and XADM (OR 0.46; CrI 0.23 – 0.88) had reduced seroma compared with HADM.
Conclusion:
Selecting the appropriate IBBR should evaluate effectiveness, adverse events, and cost. While it is difficult to select a universal ideal IBBR, evaluation using this network analysis may help guide both physicians and patients in their choice of procedure, especially in the case of HADM, which in this study has shown to be significantly predisposed to complications of infection and seroma. Randomised data is required comparing XADM versus synthetic meshes given the similar risk profiles but significant cost discrepancy between the techniques.
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.
