Beyond biologics: absorbable mesh as a low-cost, low-complication sling for implant-based breast reconstruction.
BACKGROUND
There is an intense push to decrease overall healthcare costs in the United States. Although the use of acellular dermal matrix in implant-based reconstruction has grown significantly over the past decade, potential drawbacks remain a source of debate. Matrices are costly and not universally available across institutions, whereas Vicryl mesh is widely available, relatively inexpensive, and resistant to bacteria biofilm formation. With the intent of maximizing the reconstructive and economic advantages of direct-to-implant breast reconstruction, the authors report the first experience in the literature using an absorbable mesh as an inferolateral sling.


METHODS
A retrospective review was performed of the first 50 consecutive patients (76 reconstructions) who underwent implant-based breast reconstruction with Vicryl mesh from August of 2011 until June of 2012.


RESULTS
Fifty patients underwent 76 direct-to-implant reconstructions with Vicryl mesh between August of 2011 and June of 2012 (mean follow-up, 1.2 years). Five breasts (6.6 percent) had complications, with only one complication resulting in implant loss (1.3 percent). Implant positioning and contour were excellent, with only two patients [three breasts (3.9 percent)] undergoing revision procedures, for size enlargement. Using costs available at the authors' institution, use of Vicryl mesh instead of acellular dermal matrix resulted in a direct material cost savings of $172,112 in 10 months.


CONCLUSIONS
Results to date have been encouraging, with a low complication rate (6.6 percent) and excellent aesthetic results. The technique has resulted in $172,112 in direct material cost savings over 10 months. Continued follow-up is planned to evaluate long-term results.


METHODS
Therapeutic, IV.
Boston, Mass. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School.
Oren
O
Tessler
Richard G
RG
Reish
Daniel Y
DY
Maman
Barbara L
BL
Smith
William G
WG
Austen
D020341:Absorbable Implants / Q000009:adverse effects / Q000191:economics*; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D019928:Breast Implantation / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects / Q000191:economics*
D001672:Biocompatible Materials