De novo experience of resorbable woven mesh in immediate breast reconstruction post-mastectomy
Implant based reconstruction (IBR) is the most common form of breastreconstruction. IBR has advantages; uncomplicated surgery, no donor site and goodaesthetic outcome. However, disadvantages include infection with implant loss andphysical limitation to the size of breast which can be used. The use of surgical matricesto increase the size of implants used has gained in popularity, however concernsregarding increased complication rates exists. Here we describe our initial experienceusing a resorbable mesh in post mastectomy patients.
Post mastectomy patients after cancer surgery or for risk reducing surgerywere examined. We examined our initial experience over an 18 month period ofpatients undergoing reconstruction with the use of resorbable mesh and implant basedreconstruction. Patients were followed for major or minor complications including flap necrosis, implant loss, haematoma, seroma and infection rates.
Few major complications were encountered. There were no instances of flap necrosis or haematoma formation. However, 5 reconstructed breasts (n=74, 6.7%)resulted in loss of the implant due to infection. These losses were associated withpatients who were either current or ex-smokers, or in patients who had or wereundergoing either radiation or chemotherapy. Minor complications such as superficialwound infections were seen in 8 of 74 (10.8%) reconstructed breasts. The overallcomplication rate was 17.5%, or 13 of 74 reconstructed breasts.
The use of resorbable mesh provides excellent cosmetic outcomes withminimal complications. To avoid major complications discretion should be used inpatients with risk factors such as smoking and radiation therapy.
Level of Evidence: Level IV, therapeutic study.
KeywordsBreast Reconstruction Mesh Post-mastectomy Implant Expander Radiation Brca Oncology Acelullar dermal matrix
- 1.Veiga DF, Veiga-Filho J, Ribeiro LM et al (2011) Evaluations of aesthetic outcomes of oncoplastic surgery by surgeons of different gender and specialty: a prospective controlled study. Breast 20:407–412Google Scholar
- 2.Ng SK, Hare RM, Kuang RJ et al (2014) Breast reconstruction post mastectomy. Ann Plast Surg. doi:10.1097/SAP.0000000000000242
- 6.Mitchell RE (2013) Porcine acellular dermis-assisted breast reconstruction: influence of adjuvant radiotherapy on complications and outcomes. Plast Reconstr Surgery Glob open 1(e77)Google Scholar
- 7.American Society of Plastic Surgeons. Plastic Surgery Procedural Statistics (ASPS) (2014). http://www.plasticsurgery.org/news/plastic-surgery-statistics.html (accessed 10 January 2016)
- 8.Reddy S, Colakoglu S, Curtis MS et al. (2011) Breast cancer recurrence following postmastectomy reconstruction compared to mastectomy with no reconstruction. Ann Plast Surg 66:466–471Google Scholar
- 9.Allweis TM, Boisvert ME, Otero SE et al (2002) Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy. Am J Surg 183:218–221Google Scholar
- 13.LifeCell. AlloDerm® Regenerative Tissue Matrix. (2014). at x, http://www.lifecell.com/healthcare-professionals/lifecell-products/allodermr-regenerative-tissue-matrix/ (accessed 25 May 2016)
- 14.Barber MD, Williams L, Anderson ED et al (2015) Outcome of the use of acellular-dermal matrix to assist implant-based breast reconstruction in a single Centre. Eur J Surg Oncol 41:100–105Google Scholar
- 15.Gerber B, Marx M, Untch M, Faridi A (2015) Breast reconstruction following cancer treatment. Dtsch Ärzteblatt Int 112:593–600Google Scholar
- 18.Mendenhall SD, Anderson LA, Ying J et al (2015) The BREASTrial: stage I. Outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction. Plast Reconstr Surg 135:29e–42eGoogle Scholar
- 19.Kim JY, Davila AA, Persing S et al (2012) A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. Plast Reconstr Surg 129:28–41Google Scholar