The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction

Abstract

Background Reinforcement of the abdominal wall with synthetic mesh in autologous breast reconstruction using abdominal free tissue transfer decreases the risk of bulging and herniation. However, the impact of the plane of mesh placement on donor site complications has not yet been investigated. Methods We performed a retrospective analysis of 312 patients who had undergone autologous breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps or deep inferior epigastric perforator (DIEP) flaps as well as polypropylene mesh implantation at the donor site. Donor site complications were compared among patients with different flap types and different mesh positions including overlay (n = 90), inlay and overlay (I-O; n = 134), and sublay (n = 88). Results Abdominal hernias occurred in 2.86% of patients who had undergone MS-TRAM reconstructions and in 2.63% of patients who had undergone DIEP reconstructions. When comparing patients with different mesh positions, donor site complications occurred in 14.4% of patients with overlay mesh, 13.4% of patients with I-O mesh, and 10.2% of patients with sublay mesh (P = 0.68). Abdominal hernias occurred in 4.44% of patients with overlay mesh, 2.24% of patients with I-O mesh, and 2.27% of patients with sublay mesh (P = 0.69). Multivariable logistic regression analysis did not identify a significant association between mesh position and hernia rates as well as wound complications. Conclusions Our data indicate that the plane of synthetic mesh placement in relation to the rectus abdominis muscle does not impact the rate of postoperative donor site complications in patients undergoing breast reconstruction with MS-TRAM or DIEP flaps.

Evaluation of Microvascular Autologous Breast Reconstruction in Patients Older Than 60 Years

“…They were also used in various planes relative to the rectus muscle, although early evidence suggests the plane of mesh does not significantly impact donor-site outcomes. 34 What can be gathered from our data in combination with the previously published literature is that mesh use may help provide additional abdominal support to protect from abdominal hernia and bulging even in DIEP flaps. In our cohort, there were no differences in mesh use or type of mesh between the older and younger patient cohorts.…”

“…Our own institutional data show a variety of mesh types ranging from permanent Prolene mesh, to absorbable options such as Strattice, Ovitex, and, most recently, Phasix mesh. They were also used in various planes relative to the rectus muscle, although early evidence suggests the plane of mesh does not significantly impact donor-site outcomes 34 . What can be gathered from our data in combination with the previously published literature is that mesh use may help provide additional abdominal support to protect from abdominal hernia and bulging even in DIEP flaps.…”

“…There are varying opinions in the literature regarding type of mesh, plane of mesh placement, and patient selection for mesh use in abdominal free-flap donor-site, closure. 34 Our own institutional data show a variety of mesh types ranging from permanent Prolene mesh, to absorbable options such as Strattice, Ovitex, and, most recently, Phasix mesh. They were also used in various planes relative to the rectus muscle, although early evidence suggests the plane of mesh does not significantly impact donor-site outcomes.…”

“…There are varying opinions in the literature regarding type of mesh, plane of mesh placement, and patient selection for mesh use in abdominal free-flap donor-site, closure 34 . Our own institutional data show a variety of mesh types ranging from permanent Prolene mesh, to absorbable options such as Strattice, Ovitex, and, most recently, Phasix mesh.…”

Erhöhung der Sicherheit in der mikrochirurgischen Brustrekonstruktion – Technik und Technologie

“…Einige Autoren empfehlen daher den Einsatz von (teil-) resorbierbaren Netzen zur Vermeidung dieser Komplikation. Dabei scheint die Lage des Netzes in Relation zum Rektusmuskel und der Rektusscheide von untergeordneter Bedeutung zu sein [27]. Die Inzidenz von Hernien konnte in einigen Studien durch den Einsatz von Netzen signifikant reduziert werden [28].…”