Less Is More: The Role of Mesh in Microsurgical Breast Reconstruction with Abdominal Flaps

  SFX Search  Buy Article Permissions and Reprints Abstract

Background The use of mesh to reinforce the abdominal wall after abdominal flap harvest has been reported to decrease the risk of bulging and herniation. However, the impact of the plane of mesh placement in relation to the anterior rectus sheath (vs. no mesh) on postoperative abdominal complications remains unclear.

Methods We retrospectively analyzed the length of stay and clinical outcomes in 158 female patients who underwent breast reconstruction with 250 free abdominal flaps. Group 1 consisted of patients who underwent polypropylene sublay–onlay (“sandwich”) mesh placement (N = 70) versus polypropylene sublay–only mesh (group 2; N = 54) versus primary fascial repair without mesh (group 3; N = 34).

Results Patient demographics and comorbidities were comparable between study groups, except for rates of neoadjuvant chemotherapy (group 1: 53% vs. group 2: 33% vs. group 3: 24% [p < 0.01]), postoperative follow-up in months (group 1: 21.5; group 2: 11.5; group 3: 7.6 [p < 0.01]), and length of stay in days (group 1: 4.9 vs. group 2: 4.4 vs. group 3: 3.3 [p < 0.01]). No differences were observed in breast flap and donor-site complications between study groups. Patients in group 3 required significantly lower oral morphine equivalent units postoperatively compared with those in groups 1 and 2 (group 1:185.5 vs. group 2: 79.7 vs. group 3: 71.6 [p < 0.01]).

Conclusion Abdominal donor-site closure without mesh was associated with a shorter length of stay and less narcotic intake without an increase in donor-site complications. These findings should be considered when deciding to place mesh for donor-site closure after abdominal flap harvest.

Keywords microsurgical reconstruction - breast reconstruction - hernia - bulge - mesh - MS-TRAM - DIEP Authors' Contribution

F.C.L. and D.N. contributed to conceptualization, formal analysis, data curation, methodology, investigation, and writing of the original draft. D.Ng. contributed to review and editing. A.M. contributed to conceptualization, methodology, investigation, writing of the original draft, writing review and editing, project administration, and supervision of the study. All the authors read and approved the final version of the manuscript.


*These authors contributed equally to the manuscript.

Publication History

Received: 15 April 2024

Accepted: 19 July 2024

Article published online:
21 August 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

留言 (0)

沒有登入
gif