Time to reconsider the use of synthetic mesh in immediate prepectoral implant-based breast reconstruction: Impact of their use on short-term outcomes

Background: Breast reconstruction practices, predominantly implant-based, have evolved, with meshes aiding in overcoming traditional limitations. However, data comparing mesh-assisted prepectoral reconstruction with implants alone are lacking. This study aimed to assess whether synthetic meshes in prepectoral reconstruction impact postoperative complications.

Material and methods: We retrospectively studied 238 prepectoral immediate implant-based breast reconstructions (IBBR) in 211 patients from 2020 to 2022. Our primary endpoint was the 90-day revision surgery rate comparing mesh and non-mesh groups. Secondary endpoints included postoperative complications: seroma formation, skin necrosis, implant exposure, hematomas, surgical site infections, and implant loss. We conducted univariate and multivariate analyses to assess complications and risk factors for postoperative revision in the entire cohort.

Results: There was a statistically significant higher rate of revision surgery in the mesh group (22 % vs. 9.0 %, p = 0.022) and more early complications in the mesh group, although there was no significant difference between the two groups. During the study period, the number of immediate IBBR significantly increased, reflecting expanded surgical indications that were no longer dependent on potential adjuvant treatments. and practices have changed. The multivariate analysis revealed no specific evidence of mesh use affecting surgical revision. However, it identified implant volume as a significant factor increasing the risk of revision surgery (p = 0.01).

Conclusion: This study underscores a significant practice shift: standardizing surgical techniques, particularly reducing mesh usage, did not lead to higher revision surgery rates. These findings suggest that the non-mesh assisted prepectoral approach is a valid technique.