Biological and synthetic mesh assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons

Abstract

These guidelines have been produced with the involvement of the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. Recommendations have been derived after a review of published data regarding the use of acellular dermal matrix (ADM), biological and synthetic mesh in breast reconstruction. The guidelines represent a consensus opinion on the optimal management of patients having biological or synthetic mesh assisted breast reconstruction informed by peer-review publications. The Guidelines should be used to inform clinical decision making. Ultimately, members of the MDT remain responsible for the treatment of patients under their care.

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

“…The most common use is in immediate subpectoral reconstruction, acting as an extension of the pectoralis major muscle. In this way, the mesh is fixed to the inferolateral portion of the muscle and to the submammary fold, to fill the space between the muscle and the fascia, and thus recreate the lower pole of the breast [20].…”

Best-BRA (Is subpectoral or prepectoral implant placement best in immediate breast reconstruction?): a protocol for a pilot randomised controlled trial of subpectoral versus prepectoral immediate implant-based breast reconstruction in women following mastectomy

“…[7][8][9][10][11][12][13][14] There are, however, limited data to support the safety or effectiveness of mesh-assisted subpectoral techniques. [15][16][17][18][19] The lack of high-quality evidence to support practice is highlighted in the recently updated UK mesh-assisted breast reconstruction guidelines 20 and in March 2021, the United States Food and Drug Administration issued a Safety Communication stating that acellular dermal matrices, the most commonly used form of biological mesh, are not licenced for use in breast reconstruction and recommended careful discussion of the risks and benefits of mesh with women considering surgery. 21 Despite this mesh-assisted procedures have become established as the standard of care in the UK, with two-thirds of the 2108 patients undergoing IBBR between 2014 and 2016 in the UK iBRA multicentre prospective cohort study having mesh.…”

Comparing the Outcomes and Complication Rates of Biologic vs Synthetic Meshes in Implant-Based Breast Reconstruction

“…Ultimately, the perceived advantages of surgical mesh use in IBBR are better control of the inframammary fold, improved immediate esthetic outcomes, soft tissue reinforcement, and the ability to perform single-stage direct-to-implant reconstructions without the need for tissue expansion and multiple procedures. 12,13 Currently, surgical meshes are divided into 2 broad categories: biologics and synthetics. Biologic mesh, or acellular dermal matrix (ADM), is composed of animal or human tissue that has been stripped of its antigenic cells and processed into a matrix of collagen and elastin.…”

“…In IBBR, mesh not only reinforces tissue and provides a scaffold for revascularization and cell repopulation 10 but also provides implant coverage and support, 2 facilitating easier prepectoral and submuscular reconstructions. Ultimately, the perceived advantages of surgical mesh use in IBBR are better control of the inframammary fold, improved immediate esthetic outcomes, soft tissue reinforcement, and the ability to perform single-stage direct-to-implant reconstructions without the need for tissue expansion and multiple procedures 12,13 …”