PDF herunterladen
J Reconstr Microsurg 2025; 41(04): 347-352
DOI: 10.1055/s-0044-1788929
Original Article

Less Is More: The Role of Mesh in Microsurgical Breast Reconstruction with Abdominal Flaps

Farrah C. Liu‡   *
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
,
Daniel Najafali‡   *
2   Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
,
Dung Nguyen
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
,
Arash Momeni 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
› Institutsangaben
Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background The use of mesh to reinforce the abdominal wall after abdominal flap harvest has been reported to decrease the risk of bulging and herniation. However, the impact of the plane of mesh placement in relation to the anterior rectus sheath (vs. no mesh) on postoperative abdominal complications remains unclear.

Methods We retrospectively analyzed the length of stay and clinical outcomes in 158 female patients who underwent breast reconstruction with 250 free abdominal flaps. Group 1 consisted of patients who underwent polypropylene sublay–onlay (“sandwich”) mesh placement (N = 70) versus polypropylene sublay–only mesh (group 2; N = 54) versus primary fascial repair without mesh (group 3; N = 34).

Results Patient demographics and comorbidities were comparable between study groups, except for rates of neoadjuvant chemotherapy (group 1: 53% vs. group 2: 33% vs. group 3: 24% [p < 0.01]), postoperative follow-up in months (group 1: 21.5; group 2: 11.5; group 3: 7.6 [p < 0.01]), and length of stay in days (group 1: 4.9 vs. group 2: 4.4 vs. group 3: 3.3 [p < 0.01]). No differences were observed in breast flap and donor-site complications between study groups. Patients in group 3 required significantly lower oral morphine equivalent units postoperatively compared with those in groups 1 and 2 (group 1:185.5 vs. group 2: 79.7 vs. group 3: 71.6 [p < 0.01]).

Conclusion Abdominal donor-site closure without mesh was associated with a shorter length of stay and less narcotic intake without an increase in donor-site complications. These findings should be considered when deciding to place mesh for donor-site closure after abdominal flap harvest.

Keywords

microsurgical reconstruction - breast reconstruction - hernia - bulge - mesh - MS-TRAM - DIEP

Authors' Contribution

F.C.L. and D.N. contributed to conceptualization, formal analysis, data curation, methodology, investigation, and writing of the original draft. D.Ng. contributed to review and editing. A.M. contributed to conceptualization, methodology, investigation, writing of the original draft, writing review and editing, project administration, and supervision of the study. All the authors read and approved the final version of the manuscript.


* These authors contributed equally to the manuscript.




Publikationsverlauf

Eingereicht: 15. April 2024

Angenommen: 19. Juli 2024

Artikel online veröffentlicht:
21. August 2024

© 2024. Thieme. All rights reserved.

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

 

  • References

  • 1 Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg 1971; 47 (06) 565-567
    CrossrefPubMedSuche in Google Scholar
  • 2 Tevlin R, Sharma AD, Griffin M, Wan D, Momeni A. Technical tips to reduce implant rippling in staged pre-pectoral breast reconstruction. Aesthetic Plast Surg 2023; 47 (06) 2351-2359
    CrossrefPubMedSuche in Google Scholar
  • 3 Momeni A, Kanchwala S. Hybrid prepectoral breast reconstruction: a surgical approach that combines the benefits of autologous and implant-based reconstruction. Plast Reconstr Surg 2018; 142 (05) 1109-1115
    CrossrefPubMedSuche in Google Scholar
  • 4 Momeni A, Kanchwala S, Sbitany H. Oncoplastic procedures in preparation for nipple-sparing mastectomy and autologous breast reconstruction: controlling the breast envelope. Plast Reconstr Surg 2020; 145 (04) 914-920
    CrossrefPubMedSuche in Google Scholar
  • 5 Li AY, Momeni A. Abdominal flap-based breast reconstruction versus abdominoplasty: the impact of surgical procedure on scar location. Plast Reconstr Surg Glob Open 2020; 8 (09) e3112
    CrossrefPubMedSuche in Google Scholar
  • 6 Momeni A. [Hybrid breast reconstruction following mastectomy]. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie. Organ Deutschsprachigen Arbeitsgemeinschaft Mikrochirurgie Peripheren Nerven Gefasse 2022; 54 (04) 297-304
    PubMedSuche in Google Scholar
  • 7 Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg 2018; 153 (10) 891-899
    CrossrefPubMedSuche in Google Scholar
  • 8 Nelson JA, Allen Jr RJ, Polanco T. et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients. Ann Surg 2019; 270 (03) 473-483
    CrossrefPubMedSuche in Google Scholar
  • 9 Pusic AL, Matros E, Fine N. et al. Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol 2017; 35 (22) 2499-2506
    CrossrefPubMedSuche in Google Scholar
  • 10 Pannucci CJ, Basta MN, Kovach SJ, Kanchwala SK, Wu LC, Serletti JM. Loupes-only microsurgery is a safe alternative to the operating microscope: an analysis of 1,649 consecutive free flap breast reconstructions. J Reconstr Microsurg 2015; 31 (09) 636-642
    Thieme ConnectPubMedSuche in Google Scholar
  • 11 Mrad MA, Al Qurashi AA, Shah Mardan QNM. et al. Predictors of complications after breast reconstruction surgery: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2022; 10 (12) e4693
    CrossrefPubMedSuche in Google Scholar
  • 12 Wu SS, Raymer C, Culbert A. et al. Predictors of complications in autologous breast reconstruction using DIEP flaps: implications for management. Plast Reconstr Surg 2023; 152 (04) 566e-577e
    PubMedSuche in Google Scholar
  • 13 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
    PubMedSuche in Google Scholar
  • 14 Chang EI. Latest advancements in autologous breast reconstruction. Plast Reconstr Surg 2021; 147 (01) 111e-122e
    CrossrefPubMedSuche in Google Scholar
  • 15 Kelley BP, Ahmed R, Kidwell KM, Kozlow JH, Chung KC, Momoh AO. A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal?. Ann Surg Oncol 2014; 21 (05) 1732-1738
    CrossrefPubMedSuche in Google Scholar
  • 16 Macadam SA, Zhong T, Weichman K. et al. Quality of life and patient-reported outcomes in breast cancer survivors: a multicenter comparison of four abdominally based autologous reconstruction methods. Plast Reconstr Surg 2016; 137 (03) 758-771
    CrossrefPubMedSuche in Google Scholar
  • 17 Costanzo D, Klinger M, Lisa A, Maione L, Battistini A, Vinci V. The evolution of autologous breast reconstruction. Breast J 2020; 26 (11) 2223-2225
    CrossrefPubMedSuche in Google Scholar
  • 18 Rozen WM, Ashton MW. Modifying techniques in deep inferior epigastric artery perforator flap harvest with the use of preoperative imaging. ANZ J Surg 2009; 79 (09) 598-603
    CrossrefPubMedSuche in Google Scholar
  • 19 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
    PubMedSuche in Google Scholar
  • 20 Wu LC, Bajaj A, Chang DW, Chevray PM. Comparison of donor-site morbidity of SIEA, DIEP, and muscle-sparing TRAM flaps for breast reconstruction. Plast Reconstr Surg 2008; 122 (03) 702-709
    CrossrefPubMedSuche in Google Scholar
  • 21 Deptula P, Zak Y, Dua M, Wapnir I, Nguyen D. Minimizing postoperative pain in autologous breast reconstruction with the omental fat-augmented free flap. Ann Plast Surg 2022; 88 (4, Suppl 4): S374-S378
    CrossrefPubMedSuche in Google Scholar
  • 22 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
    CrossrefPubMedSuche in Google Scholar
  • 23 Espinosa-de-Los-Monteros A, Frias-Frias R, Alvarez-Tostado-Rivera A, Caralampio-Castro A, Llanes S, Saldivar A. Postoperative abdominal bulge and hernia rates in patients undergoing abdominally based autologous breast reconstruction: systematic review and meta-analysis. Ann Plast Surg 2021; 86 (04) 476-484
    CrossrefPubMedSuche in Google Scholar
  • 24 Yu D, Patel AT, Rossi K, Topham NS, Chang EI. Comparison of Phasix, polypropylene, and primary closure of the abdominal donor site after bilateral free flap breast reconstruction: long-term evaluation of abdominal hernia and bulge formation. Microsurgery 2020; 40 (04) 434-439
    CrossrefPubMedSuche in Google Scholar
  • 25 Kraft CT, Molina BJ, Skoracki RJ. Polypropylene mesh complications in the sublay position after abdominally based breast reconstruction: les complications des treillis de polypropylène en sous-couche après une reconstruction mammaire par voie abdominale. Plast Surg (Oakv) 2021; 29 (01) 16-20
    CrossrefPubMedSuche in Google Scholar
  • 26 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
    CrossrefPubMedSuche in Google Scholar
  • 27 Momeni A, Heier M, Bannasch H, Stark GB. Complications in abdominoplasty: a risk factor analysis. J Plast Reconstr Aesthet Surg 2009; 62 (10) 1250-1254
    CrossrefPubMedSuche in Google Scholar
  • 28 Momeni A, Remington AC, Wan DC, Nguyen D, Gurtner GC. A matched-pair analysis of prepectoral with subpectoral breast reconstruction: is there a difference in postoperative complication rate?. Plast Reconstr Surg 2019; 144 (04) 801-807
    CrossrefPubMedSuche in Google Scholar
  • 29 Tevlin R, Wan DC, Momeni A. Should free deep inferior epigastric artery perforator flaps be considered a quality indicator in breast reconstruction?. J Plast Reconstr Aesthet Surg 2019; 72 (12) 1923-1929
    CrossrefPubMedSuche in Google Scholar
  • 30 Edalatpour A, Attaluri P, Shaffrey EC, Seitz A, Poore SO, Afifi AM. The nuances of abdominal free flap harvest: technical and patient factors affecting abdominal donor site morbidity in autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 81: 105-118
    CrossrefPubMedSuche in Google Scholar
  • 31 Henn D, Sivaraj D, Barrera JA. et al. The plane of mesh placement does not impact abdominal donor site complications in microsurgical breast reconstruction. Ann Plast Surg 2021; 87 (05) 542-546
    CrossrefPubMedSuche in Google Scholar
  • 32 Lee WS, Park SO, Kim IK. Prevention of abdominal bulging using onlay dermal autografts from discarded zone IV TRAM flap tissue. J Clin Med 2022; 11 (07) 1929
    CrossrefPubMedSuche in Google Scholar
  • 33 Siegwart LC, Sieber L, Fischer S. et al. The use of semi-absorbable mesh and its impact on donor-site morbidity and patient-reported outcomes in DIEP flap breast reconstruction. Aesthetic Plast Surg 2021; 45 (03) 907-916
    PubMedSuche in Google Scholar
  • 34 Cobb WS. A current review of synthetic meshes in abdominal wall reconstruction. Plast Reconstr Surg 2018; 142 (3, Suppl): 64S-71S
    CrossrefPubMedSuche in Google Scholar
  • 35 Lak KL, Goldblatt MI. Mesh selection in abdominal wall reconstruction. Plast Reconstr Surg 2018; 142 (3, Suppl): 99S-106S
    CrossrefPubMedSuche in Google Scholar
  • 36 Klinge U, Klosterhalfen B, Müller M, Schumpelick V. Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 1999; 165 (07) 665-673
    CrossrefPubMedSuche in Google Scholar
  • 37 Todros S, Pavan PG, Natali AN. Synthetic surgical meshes used in abdominal wall surgery: part I—materials and structural conformation. J Biomed Mater Res B Appl Biomater 2017; 105 (03) 689-699
    CrossrefPubMedSuche in Google Scholar
  • 38 Patel KM, Shuck J, Hung R, Hannan L, Nahabedian MY. Reinforcement of the abdominal wall following breast reconstruction with abdominal flaps: a comparison of synthetic and biological mesh. Plast Reconstr Surg 2014; 133 (03) 700-707
    CrossrefPubMedSuche in Google Scholar
  • 39 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
    CrossrefPubMedSuche in Google Scholar
  • 40 Rodnoi P, Dickey RM, Teotia SS, Haddock NT. Increased opioid consumption following DIEP flap breast reconstruction: effect of depression and anxiety. J Reconstr Microsurg 2022; 38 (09) 742-748
    Thieme ConnectPubMedSuche in Google Scholar
  • 41 Marquez JL, Chow J, Moss W. et al. Outpatient prescription opioid use following discharge after deep inferior epigastric perforator breast reconstruction with and without an educational intervention. J Reconstr Microsurg 2024
    PubMed