Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh

Abstract

Background Biological and synthetic meshes may improve the outcomes of immediate implant-based breast reconstruction (IBBR) by facilitating single-stage procedures and improving cosmesis. Supporting evidence is, however, limited. The aim of this study was to explore the impact of biological and synthetic mesh on patient-reported outcomes (PROs) of IBBR 18 months after surgery. Methods Consecutive women undergoing immediate IBBR between February 2014 and June 2016 were recruited to the study. Demographic, operative, oncological and 3-month complication data were collected, and patients received validated BREAST-Q questionnaires at 18 months. The impact of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically relevant confounders, and including a random effect to account for clustering by centre. Results A total of 1470 participants consented to receive the questionnaire and 891 completed it. Of these, 67 women underwent two-stage submuscular reconstructions. Some 764 patients had a submuscular reconstruction with biological mesh (495 women), synthetic mesh (95) or dermal sling (174). Fourteen patients had a prepectoral reconstruction. Compared with two-stage submuscular reconstructions, no significant differences in PROs were seen in biological or synthetic mesh-assisted or dermal sling procedures. However, patients undergoing prepectoral IBBR reported better satisfaction with breasts (adjusted mean difference +6.63, 95 per cent c.i. 1.65 to11.61; P = 0.009). PROs were similar to those in the National Mastectomy and Breast Reconstruction Audit 2008–2009 cohort, which included two-stage submuscular procedures only. Conclusion This study found no difference in PROs of subpectoral IBBR with or without biological or synthetic mesh, but provides early data to suggest improved satisfaction with breasts following prepectoral reconstruction. Robust evaluation is required before this approach can be adopted as standard practice.

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

“…This highlights the importance of careful patient selection in combination with meticulous perioperative practice [22,26] to optimise outcomes for patients undergoing mesh-assisted IBR procedures. Of note, despite the proposed benefits of mesh-assisted procedures, the 3-month clinical [4] and 18-month patient-reported outcomes [27] from the iBRA study were largely consistent with the outcomes of two-stage expanderimplant reconstruction without mesh reported in the UK National Mastectomy and Breast Reconstruction Audit [28].…”

Systematic Review of Breast-Q: A Tool to Evaluate Post-Mastectomy Breast Reconstruction

“… Qureshi et al (2017) 25 United States Prospective 59 44(11) Autologous, mesh 37. Sewart et al (2020) 81 United Kingdom Prospective 891 Median(range) 50(45–58) Autologous and IBBRS 38. Eltahir et al (2014) 82 Netherlands Retrospective 92 Median(range) Autologous: 51(35–78); Implant: 44.0(26.62) DIEP flap 39.…”

Breakthrough in breast reconstruction in the context of COVID-19: safety and efficiency of endoscopic breast reconstruction at a day surgery center

“…In terms of postoperative esthetics, compared to some reported postoperative satisfaction scores of 57-59 for open reconstruction in patients with a follow up of more than 1 year (19,20), all three groups of patients in the present study had higher satisfaction at 3 months postoperatively (WEP vs WMP vs DSP = 57.38 vs. 57.84 vs. 60.77), and we believe that with gradual recovery and scar fading, postoperative breast satisfaction will further improve. Similarly, the surgical scar with robot-assisted reconstruction was also more often located in the axilla, which was not easily detected, and breast satisfaction was higher than with open reconstruction (21).…”