Are patients most satisfied with a synthetic or a biological mesh in dual-plane immediate breast reconstruction after 5 years? A randomized controlled trial comparing the two meshes in the same patient

Paganini, Anna; Meyer, Susanne; Hallberg, Håkan; Hansson, Emma

doi:10.1016/j.bjps.2022.08.013

Cited by 4 publications

(2 citation statements)

References 44 publications

(58 reference statements)

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“…Generally, they are lower in cost to ADMs [20]. Some studies have reported reduced or no infection or seroma formation post surgery with synthetic mesh, with aesthetic outcomes and patient satisfaction comparable with both synthetic and biological mesh [16,44]. Synthetic meshes have poor incorporation into host tissue, which is one drawback to this surgical technique; of all synthetic materials used in meshes, PL is reported as having better incorporation [16].…”

Section: Syntheticmentioning

confidence: 99%

Meshes in Implant-Based Breast Reconstruction: The Science and Technology

Louise Hopwood,

Xiao Yan Tan,

Jane Tsang-Wright

2024

Breast Reconstruction - Conceptual Evolution

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Breast reconstruction is a common choice post mastectomy or breast-conserving surgery for breast cancer. Reconstructive options currently include implant-based and autologous reconstruction, with adjunctive use of surgical meshes. Acellular dermal matrices (ADMs) of both human and animal origin, and synthetic meshes are well-established for use in implant reconstruction. With ADMs, there is reduced risk of capsular contracture, providing a strong scaffold for prosthetic-based immediate reconstruction. Reduced seroma formation and infection has been demonstrated with synthetic mesh, thus both techniques proving advantageous. Use of mesh in implant-based reconstruction is a quickly evolving field, with hybrid meshes, 3D printed meshes and antibiotic-loaded meshes being investigated within the current literature. Whilst these surgical techniques are relatively new, they provide a new approach to many of the ethical issues currently surrounding use of surgical mesh.

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Section: Syntheticmentioning

confidence: 99%

Meshes in Implant-Based Breast Reconstruction: The Science and Technology

Louise Hopwood,

Xiao Yan Tan,

Jane Tsang-Wright

2024

Breast Reconstruction - Conceptual Evolution

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“…• Different types of implants/tissue expanders [31][32][33][34] • ADM versus no ADM [35][36][37][38][39][40][41] • Different types of ADMs and meshes [11,[42][43][44][45][46][47][48] • Fast versus slow tissue expansion [49][50][51][52] • One versus two stages [53][54][55] • Fat transfer/Lipofilling as an adjunct [56] Autologous breast reconstruction…”

Section: Implant-based Breast Reconstructionmentioning

confidence: 99%

A systematic review of randomised controlled trials in breast reconstruction

Hansson,

Larsson,

Uusimäki

et al. 2024

JPHS

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Background: For preference sensitive treatments, such as breast reconstructions, there are barriers to conducting randomised controlled trials (RCTs). The primary aims of this systematic review were to investigate what type of research questions are explored by RCTs in breast reconstruction, where have they been performed and where have they been published, and to thematise the research questions and thus create an overview of the state of the research field. Methods: Randomised controlled trials investigating any aspect of breast reconstructions were included. The PubMed database was searched with a pre-defined search string. Inclusion and data abstraction was performed in a pre-defined standardised fashion. For the purpose of this study, we defined key issues as comparison of categories of breast reconstruction and comparison of immediate and delayed breast reconstruction, when the thematisation was done. Results: A total of 419 abstracts were retrieved from the search. Of the 419, 310 were excluded as they were not RCTs concerning some aspect of breast reconstruction, which left us with 110 abstracts to be included in the study. The research questions of the included studies could more or less be divided into seven different themes inclusive of 2 key issues: Other issues – comparison of different categories of breast reconstruction, comparison of immediate and delayed breast reconstruction, surgical details within a category of breast reconstruction, surgical details valid for several categories of breast reconstruction, donor site management, anaesthetics, and non-surgical details. Only five studies compared key issues, and they all illustrate the challenges with RCTs in breast reconstruction. Conclusions: A total of 110 publications based on RCTs in breast reconstruction have been published. Seven themes of research questions could be identified. Only five studies have explored the key issues. Better scientific evidence is needed for the key issues in breast reconstruction, for example by implementing a new study design in the field.

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A Comparison of Capsular Contracture Rates after Immediate Implant-based Breast Reconstruction Using Biologic versus Synthetic Mesh

Ferenz,

Bai,

Fracol

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Capsular contracture is one of the most common reasons for reoperation after implant-based breast reconstruction. Prior investigations have suggested that biologic mesh may mitigate capsular contracture development. This study sought to compare capsular contracture rates between patients undergoing immediate implant-based breast reconstruction with biologic versus synthetic mesh. Methods: A retrospective review was conducted of the senior author’s primary implant-based breast reconstructions between 2008 and 2023. Demographics and the incidence of clinically significant Baker grade III or IV capsular contractures were compared between biologic and synthetic mesh cohorts. Univariate and multivariate logistic regressions were then performed to assess potential risk factors for the development of capsular contracture. Results: A total of 772 breasts underwent immediate reconstruction, of which 689 (89.2%) used biologic and 83 (10.8%) used synthetic mesh. Capsular contracture occurred in 15 (2.2%) biologic mesh breasts and three (3.6%) synthetic mesh breasts with no significant difference between the two groups (P = 0.430). Logistic regression showed that radiation was a borderline significant risk factor for developing capsular contracture, but the use of either biologic or synthetic mesh was not significant (P = 0.351). Conclusions: Biologic and synthetic meshes function as effective tools in prosthetic breast reconstruction. Our long-term data suggest that the risk of capsular contracture with these devices is low, and there does not seem to be a difference between the two materials. However, there does need to be a shift in how capsular contracture is assessed and discussed in the reconstruction population.

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Are patients most satisfied with a synthetic or a biological mesh in dual-plane immediate breast reconstruction after 5 years? A randomized controlled trial comparing the two meshes in the same patient

Cited by 4 publications

References 44 publications

Meshes in Implant-Based Breast Reconstruction: The Science and Technology

Meshes in Implant-Based Breast Reconstruction: The Science and Technology

A systematic review of randomised controlled trials in breast reconstruction

A Comparison of Capsular Contracture Rates after Immediate Implant-based Breast Reconstruction Using Biologic versus Synthetic Mesh

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