Comparison of Polypropylene and Bioabsorbable Mesh for Abdominal Wall Reinforcement following Microsurgical Breast Reconstruction
19 June 2018
18 October 2018
17 December 2018 (eFirst)
Background Abdominal wall morbidity following microvascular breast reconstruction continues to be an area of interest due to both functional and aesthetic concerns. Donor-site closure technique has been shown to affect bulge and hernia rates and ranges from primary closure to various uses of mesh. Few studies to date have compared types of mesh. The present study compares BARD polypropylene to bioabsorbable GORE Bio-A (polyglycolic acid/trimethylene carbonate) mesh used as a fascial underlay with primary fascial closure.
Methods A retrospective review of all consecutive deep inferior epigastric artery-based microvascular breast reconstructions, including perforator and muscle-sparing flaps, performed between September 2014 and February 2017 was performed. All patients underwent primary fascial closure with mesh underlay. Risk factors for the formation of an abdominal bulge or hernia were identified by multivariate logistic regression.
Results Eighty-seven patients, with 123 abdominal donor sites, were included. Heavy-weight polypropylene mesh was used for 58 donor sites, while polyglycolic acid/trimethylene carbonate mesh was used in 65 donor sites. The overall incidence of bulge or hernia was 11.4%. The bioabsorbable cohort experienced significantly more bulges/hernias than the polypropylene mesh cohort (20% vs. 1.7% by donor site). Time to diagnosis of bulge was longer for the bioabsorbable group (219 ± 107 vs. 69 days). Flap type and perforator row were not associated with bulge/hernia. The polyglycolic acid/trimethylene carbonate mesh was associated with a 13.3-fold risk of bulge/hernia (p = 0.016).
Conclusion Polyglycolic acid/trimethylene carbonate mesh is not appropriate for anterior rectus fascia reinforcement following abdominal tissue transfer.
The authors have no financial or nonfinancial disclosures related to this manuscript.
- 1 Erdmann-Sager J, Wilkins EG, Pusic AL. , et al. Complications and patient-reported outcomes after abdominally based breast reconstruction: results of the Mastectomy Reconstruction Outcomes Consortium study. Plast Reconstr Surg 2018; 141 (02) 271-281
- 2 Shubinets V, Fox JP, Sarik JR, Kovach SJ, Fischer JP. Surgically treated hernia following abdominally based autologous breast reconstruction: prevalence, outcomes, and expenditures. Plast Reconstr Surg 2016; 137 (03) 749-757
- 3 Ascherman JA, Seruya M, Bartsich SA. Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 117 consecutive patients. Plast Reconstr Surg 2008; 121 (01) 1-8
- 4 Boehmler IV JH, Butler CE, Ensor J, Kronowitz SJ. Outcomes of various techniques of abdominal fascia closure after TRAM flap breast reconstruction. Plast Reconstr Surg 2009; 123 (03) 773-781
- 5 Chang EI, Chang EI, Soto-Miranda MA. , et al. Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction. Plast Reconstr Surg 2013; 132 (06) 1383-1391
- 6 Wan DC, Tseng CY, Anderson-Dam J, Dalio AL, Crisera CA, Festekjian JH. Inclusion of mesh in donor-site repair of free TRAM and muscle-sparing free TRAM flaps yields rates of abdominal complications comparable to those of DIEP flap reconstruction. Plast Reconstr Surg 2010; 126 (02) 367-374
- 7 Atisha D, Alderman AK. A systematic review of abdominal wall function following abdominal flaps for postmastectomy breast reconstruction. Ann Plast Surg 2009; 63 (02) 222-230
- 8 Bajaj AK, Chevray PM, Chang DW. Comparison of donor-site complications and functional outcomes in free muscle-sparing TRAM flap and free DIEP flap breast reconstruction. Plast Reconstr Surg 2006; 117 (03) 737-746 , discussion 747–750
- 9 Chun YS, Sinha I, Turko A. , et al. Comparison of morbidity, functional outcome, and satisfaction following bilateral TRAM versus bilateral DIEP flap breast reconstruction. Plast Reconstr Surg 2010; 126 (04) 1133-1141
- 10 Garvey PB, Salavati S, Feng L, Butler CE. Abdominal donor-site outcomes for medial versus lateral deep inferior epigastric artery branch perforator harvest. Plast Reconstr Surg 2011; 127 (06) 2198-2205
- 11 Jordan SW, Fligor JE, Janes LE, Dumanian GA. Implant porosity and the foreign body response. Plast Reconstr Surg 2018; 141 (01) 103e-112e
- 12 Wormer BA, Clavin NW, Lefaivre JF. , et al. Reducing postoperative abdominal bulge following deep inferior epigastric perforator flap breast reconstruction with onlay monofilament poly-4-hydroxybutyrate biosynthetic mesh. J Reconstr Microsurg 2017; 33 (01) 8-18
- 13 Chatterjee A, Ramkumar DB, Dawli TB, Nigriny JF, Stotland MA, Ridgway EB. The use of mesh versus primary fascial closure of the abdominal donor site when using a transverse rectus abdominis myocutaneous flap for breast reconstruction: a cost-utility analysis. Plast Reconstr Surg 2015; 135 (03) 682-689
- 14 W. L. Gore & Associates. GORE ® BIO-A ® Tissue Reinforcement Product Overview. Available at: https://www.goremedical.com/products/bioatissue . Accessed April 11, 2018
- 15 Parrett BM, Caterson SA, Tobias AM, Lee BT. DIEP flaps in women with abdominal scars: are complication rates affected?. Plast Reconstr Surg 2008; 121 (05) 1527-1531
- 16 Peeters E, van Barneveld KW, Schreinemacher MH. , et al. One-year outcome of biological and synthetic bioabsorbable meshes for augmentation of large abdominal wall defects in a rabbit model. J Surg Res 2013; 180 (02) 274-283