Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2023; 50(01): 003-009
DOI: 10.1055/a-1964-8181
Breast/Trunk
Original Article

Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis

Young-Soo Choi 
1   Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
,
Hi-Jin You 
1   Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
,
Tae-Yul Lee 
1   Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
,
Deok-Woo Kim 
1   Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications. However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis.

Methods We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, nonabsorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models.

Results Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or nonabsorbable types, compared with the nonmesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the nonabsorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups.

Conclusion Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

Keywords

mammaplasty - surgical mesh - network meta-analysis

Authors' Contributions

Y.S.C. and T.Y.L. conceptualized the study. Y.S.C. and H.J.Y. contributed to data curation and formal analysis. Y.S.C. and D.W.K. contributed to methodology, project administration, and visualization. YS Choi helped in writing—original draft. Y.S.C. and T.Y.L. contributed to writing—review and editing.




Publication History

Received: 04 May 2022

Accepted: 13 October 2022

Accepted Manuscript online:
20 October 2022

Article published online:
06 February 2023

© 2023. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Institute NC. Cancer statistics: Breast cancer survival . . 2012–2018; Accessed November 6, 2022, at: https://seer.cancer.gov/statistics-network/explorer/application.html?site=55&data_type=4&graph_type=5&compareBy=sex&chk_sex_3=3&chk_sex_2=2&series=9&race=1&age_range=1&stage=101&advopt_precision=1&advopt_show_ci=on#tableWrap
    Google Scholar
  • 2 Sewart E, Turner NL, Conroy EJ. et al; implant Breast Reconstruction Evaluation (iBRA) Steering Group and the Breast Reconstruction Research Collaborative. Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh. BJS Open 2021; 5 (01) zraa063
    CrossrefPubMedGoogle Scholar
  • 3 Eichler C, Schulz C, Thangarajah F, Malter W, Warm M, Brunnert K. A retrospective head-to-head comparison between TiLoop Bra/TiMesh® and Seragyn® in 320 cases of reconstructive breast surgery. Anticancer Res 2019; 39 (05) 2599-2605
    CrossrefPubMedGoogle Scholar
  • 4 Hansson E, Burian P, Hallberg H. Comparison of inflammatory response and synovial metaplasia in immediate breast reconstruction with a synthetic and a biological mesh: a randomized controlled clinical trial. J Plast Surg Hand Surg 2020; 54 (03) 131-136
    CrossrefPubMedGoogle Scholar
  • 5 Ganz OM, Tobalem M, Perneger T. et al. Risks and benefits of using an absorbable mesh in one-stage immediate breast reconstruction: a comparative study. Plast Reconstr Surg 2015; 135 (03) 498e-507e
    CrossrefPubMedGoogle Scholar
  • 6 Hutton B, Salanti G, Caldwell DM. et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015; 162 (11) 777-784
    CrossrefPubMedGoogle Scholar
  • 7 Grow JN, Butterworth J, Petty P. Alternatives to acellular dermal matrix: utilization of a Gore dualmesh sling as a cost-conscious adjunct for breast reconstruction. Eplasty 2017; 17: e4
    PubMedGoogle Scholar
  • 8 Headon H, Kasem A, Mokbel K. Capsular contracture after breast augmentation: an update for clinical practice. Arch Plast Surg 2015; 42 (05) 532-543
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Baldelli I, Cardoni G, Franchelli S. et al. Implant-based breast reconstruction using a polyester mesh (Surgimesh-PET): a retrospective single-center study. Plast Reconstr Surg 2016; 137 (06) 931e-939e
    CrossrefPubMedGoogle Scholar
  • 10 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
    CrossrefPubMedGoogle Scholar
  • 11 2020 ., R.C.T. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.; Accessed November 6, 2022, at: https://www.R-project.org/
    PubMed
  • 12 Chen G, Zhang Y, Xue J. et al. Surgical outcomes of implant-based breast reconstruction using TiLoop Bra Mesh combined with pectoralis major disconnection. Ann Plast Surg 2019; 83 (04) 396-400
    CrossrefPubMedGoogle Scholar
  • 13 Chun YS, Verma K, Rosen H. et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 2010; 125 (02) 429-436
    CrossrefPubMedGoogle Scholar
  • 14 Colwell AS, Tessler O, Lin AM. et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg 2014; 133 (03) 496-506
    CrossrefPubMedGoogle Scholar
  • 15 Dieterich M, Angres J, Stachs A. et al. Patient-report satisfaction and health-related quality of life in TiLOOP® bra-assisted or implant-based breast reconstruction alone. Aesthetic Plast Surg 2015; 39 (04) 523-533
    CrossrefPubMedGoogle Scholar
  • 16 Gao P, Wang Z, Kong X, Wang X, Fang Y, Wang J. Comparisons of therapeutic and aesthetic effects of one-stage implant-based breast reconstruction with and without biological matrix. Cancer Manag Res 2020; 12: 13381-13392
    CrossrefPubMedGoogle Scholar
  • 17 Gschwantler-Kaulich D, Schrenk P, Bjelic-Radisic V. et al. Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction - a prospective randomized trial. Eur J Surg Oncol 2016; 42 (05) 665-671
    CrossrefPubMedGoogle Scholar
  • 18 Hallberg H, Elander A, Kölby L, Hansson E. A biological or a synthetic mesh in immediate breast reconstruction? A cohort-study of long-term Health related Quality of Life (HrQoL). Eur J Surg Oncol 2019; 45 (10) 1812-1816
    CrossrefPubMedGoogle Scholar
  • 19 Hansson E, Edvinsson AC, Elander A, Kölby L, Hallberg H. First-year complications after immediate breast reconstruction with a biological and a synthetic mesh in the same patient: a randomized controlled study. J Surg Oncol 2021; 123 (01) 80-88
    CrossrefPubMedGoogle Scholar
  • 20 Hansson E, Edvinsson AC, Hallberg H. Drain secretion and seroma formation after immediate breast reconstruction with a biological and a synthetic mesh, respectively: a randomized controlled study. Breast J 2020; 26 (09) 1756-1759
    CrossrefPubMedGoogle Scholar
  • 21 Hill JL, Wong L, Kemper P, Buseman J, Davenport DL, Vasconez HC. Infectious complications associated with the use of acellular dermal matrix in implant-based bilateral breast reconstruction. Ann Plast Surg 2012; 68 (05) 432-434
    CrossrefPubMedGoogle Scholar
  • 22 Liu AS, Kao HK, Reish RG, Hergrueter CA, May Jr JW, Guo L. Postoperative complications in prosthesis-based breast reconstruction using acellular dermal matrix. Plast Reconstr Surg 2011; 127 (05) 1755-1762
    CrossrefPubMedGoogle Scholar
  • 23 Potter S, Conroy EJ, Cutress RI. et al; iBRA Steering Group, Breast Reconstruction Research Collaborative. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study. Lancet Oncol 2019; 20 (02) 254-266
    CrossrefPubMedGoogle Scholar
  • 24 Schüler K, Paepke S, Kohlmann T. et al. Postoperative complications in breast reconstruction with porcine acellular dermis and polypropylene meshes in subpectoral implant placement. In Vivo 2021; 35 (05) 2739-2746
    CrossrefPubMedGoogle Scholar
  • 25 Tessler O, Reish RG, Maman DY, Smith BL, Austen Jr WG. Beyond biologics: absorbable mesh as a low-cost, low-complication sling for implant-based breast reconstruction. Plast Reconstr Surg 2014; 133 (02) 90e-99e
    CrossrefPubMedGoogle Scholar
  • 26 Nyame TT, Lemon KP, Kolter R, Liao EC. High-throughput assay for bacterial adhesion on acellular dermal matrices and synthetic surgical materials. Plast Reconstr Surg 2011; 128 (05) 1061-1068
    CrossrefPubMedGoogle Scholar