Abstract
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.
Keywords
microvascular breast reconstruction - donor site morbidity - abdominal bulge
