The Use of Synthetic Mesh in Reconstructive, Revision, and Cosmetic Breast Surgery

Abstract

BackgroundRecent evidence suggests that the use of acellular dermal matrices in prosthetic breast reconstruction, revision, or augmentation may be associated with an increased risk of complications. In this article we report our results of a potential alternative, using a new long-term resorbable synthetic matrix in these cases.MethodsA retrospective study was performed evaluating 11 primary breast reconstructions (19 breasts), 43 secondary reconstructions (77 breasts), 3 augmentation/augmentation mastopexys (6 breasts), and 5 mastopexys (10 breasts) in 62 patients using TIGR® Matrix Surgical Mesh.ResultsFollow-up ranged from 9.4 to 26.1 months with an average follow-up of 16.5 months. Average age was 54 years. The number of patients who had prior radiation was 9 (14.5 %). Four patients (6.5 %) were smokers. Postoperative breast complications included necrosis of two flaps (1.8 %), two seromas requiring drainage (1.8 %), four infection/extrusions (3.6 %), two relapses of inframammary fold/malposition (1.8 %), and two with rippling (1.8 %). Other complications included six cases of asymmetry that required a corrective procedure. In a variety of breast surgery cases very good aesthetic results were achieved.ConclusionThe long-term absorbable synthetic matrix, TIGR® Matrix Surgical Mesh, shows potential when used as temporary reinforcement in patients undergoing breast reconstruction or breast surgery revisions and in primary aesthetic procedures, and it appears to be a viable alternative to the use of acellular dermal matrices.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Risks and Benefits of Using an Absorbable Mesh in One-Stage Immediate Breast Reconstruction

“…reconstruction, extension of the pectoralis major muscle by various types of absorbable or nonresorbable mesh and acellular dermal matrix has been used successfully 27,33,34 ; however, to our knowledge, no comparative study has yet corroborated these outcomes with the use of a resorbable Vicryl mesh.…”

“…7,9,[24][25][26]30 Tissue expansion aims to compensate for these difficulties; however, months of inflation along with multiple office visits are needed, and a two-stage procedure is required to replace the expander with a permanent implant or to remove the filling port in case of a definitive expander. 8,9,24,27,[32][33][34] Synthetic meshes have been used in various surgical fields for many years, such as in abdominal wall repair and in mastopexy procedures. 8,9,24,27,[32][33][34] Synthetic meshes have been used in various surgical fields for many years, such as in abdominal wall repair and in mastopexy procedures.…”

“…[21][22][23]31 Therefore, a one-stage procedure has been proposed with extension of the submuscular pocket by release of the inferior pectoralis major attachments and its completion by a foreign material such as biological matrices or synthetic mesh. [34][35][36] This surgical experience has demonstrated good tolerance of this foreign material. [34][35][36] This surgical experience has demonstrated good tolerance of this foreign material.…”

The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction

“…The techniques, collectively referred to as lower-pole sling reconstructions (LPSR), may avoid the need for a tissue expander by facilitating single-stage direct-to-implant reconstruction [7] and improve cosmetic outcomes through better lower-pole projection [8–15]. Various products are available and vary widely in cost from £200 for a synthetic mesh such as TiLOOP® [16] or TIGR® Matrix [17] to £1900 for biological alternative [7, 18] such as an acellular dermal matrix (e.g. Strattice® or SurgiMend®).…”

Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy with immediate breast reconstruction

“…Despite the advantages of ADMs, the related cost of the biological matrices is significant in health care systems. [100][101][102] The use of synthetic materials in BR is becoming more common as a low-cost alternative to ADMs. 103 The goal of this retrospective study of the use of ULTRAPRO ® mesh in DTI BR was to evaluate a potential, less expensive alternative to biological matrices.…”