Outcomes in Implant-Based Breast Reconstruction Utilizing Biosynthetic Mesh: A Meta-Analysis

Abstract Biosynthetic mesh has become more popular for immediate breast cancer implant-based reconstruction as an alternative to acellular dermal matrix (ADM) for soft tissue support. This meta-analysis investigates the various biosynthetic options available as well as complications and outcomes. 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. Data were combined by a pooling of proportional outcomes as inherent to meta-analysis. Heterogeneity of included studies was assessed with the Q and I2 statistical analysis. A total of 24 studies investigating six different types of mesh in 2167 individual breasts undergoing implant reconstruction were included. Summary effect sizes were calculated for the complications. 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. Overall, while differences in mesh characteristics exist, the reported rate of complications is low. Biosynthetic mesh options should be taken into consideration in breast reconstruction given their demonstrated safety, significant cost advantage, and potential decrease in short-term complications in comparison to acellular dermal matrices.