The Use of Mesh Reinforcement during Abdominoplasty: A Case Report and Literature Review

Abstract

Introduction: Abdominoplasty is a well-established procedure that consistently ranks in the top 5 most common cosmetic surgical procedures performed in the United States per year. In cases of severe myoaponeurotic laxity some surgeons choose to supplement their procedure with the placement of mesh to reinforce their plication. Some surgeons place mesh on a more routine basis. There is limited data in the literature to substantiate the use of synthetic mesh. This is a case report and review of the literature for the use of mesh reinforcement during abdominoplasty. Materials and Methods: A case report is presented, detailing the infectious complications suffered by 1 patient subsequent to abdominoplasty with mesh reinforcement. A thorough review of the literature was performed. Literature was evaluated with respect to the number of patients, age range, type of mesh, method of fixation, follow-up interval, complications, and cosmetic results. Results: Four studies were found assessing the use of mesh reinforcement during abdominoplasty. Number of patients was limited, ranging from 18 to 52. Types of mesh included Polypropylene, Prolene, and Vicryl. No infection, dehiscence, or extrusion of mesh were reported. Authors report stable repair with follow-up ranging from 6 months to 54 months in cases involving severe myoaponeurotic laxity only. Conclusions: Following review of the literature, it is clear that the evidence to support routine placement of mesh during abdominoplasty is lacking. As demonstrated by the case report described, placement of mesh in any procedure puts the patient at risk for undue sequelae. Our recommendations are as follows: Do not use mesh reinforcement during routine abdominoplasty. In only the worst cases of myoaponeurotic laxity, consider placing mesh using an onlay technique or in a submuscular layer (if experienced with this procedure), recognizing the limitations of the current literature on this subject. In either case, the surgeon should be aware of the significant risks of complications involved with these procedures, including seroma, umbilical and flap necrosis, as well as infection. If mesh is placed at the time of surgery, make certain that the patient is aware of the fact. In cases of wound infection where mesh was placed, have a high suspicion for mesh infection and a low threshold for reoperation.