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Outcomes In Post-Mastectomy Breast Reconstruction Utilizing Biosynthetic Mesh: A Meta-Analysis
Orr Shauly, MD, Alisa Arnautovic, MD, Sonya Williams, BS, Makenna Ash, BS, Ambika Menon, MD, Albert Losken, MD.
Emory University, Atlanta, GA, USA.
Purpose: Biosynthetic mesh has become more popular for immediate breast cancer implant-based reconstruction as an alternative to acellular dermal matrix for soft tissue support. This meta-analysis investigates the various biosynthetic options available as well as complications and outcomes.
Methods: PubMed, MEDLINE, and Embase were systematically reviewed for studies investigating the following types of mesh, TIGR, Vicryl, PDO, TiLOOP, Durasorb, and Galaflex, and their associated outcomes. The meta-analysis was completed in accordance with PRISMA guidelines and was performed to determine overall complication rates in patients who underwent breast reconstruction with the use of mesh.
Results: A total of 24 studies investigating six different types of mesh in 2167 individual breasts undergoing implant reconstruction were included. The pooled rate of seroma formation was 5.26% (Q = 23.81%, I2 = 37.01%) reported in 13 studies, hematoma formation was 2.5% (Q = 0.25%, I2 = 58.27%) reported in 9 studies, skin necrosis was 5.5% (Q =2.86%, I2 = 423.78%) reported in 10 studies, infection rate was 4.8% (Q = 6.02%, I2 = 149.34%) in 21 studies, and implant loss was 3.85% (Q = 6.55%, I2 =129.07%) reported in 10 studies.
Conclusions: In review of the available literature, biosynthetic mesh has been shown to be a safe and durable option for soft tissue support in implant based immediate breast reconstruction. While differences in mesh characteristics exist, the overall complication rate is low. The biosynthetic options should be taken into consideration given their extensive safety profile, cost advantage, and potential complication advantages over acellular dermal matrices.
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