title: Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients.
abstract: BACKGROUND
  Acellular dermal matrix has proven to be a useful adjunct in tissue expander or direct-to-implant breast reconstruction. Although versatile, acellular dermal matrix adds considerable cost. Vicryl (polyglactin) mesh has an established track record in many fields of surgery, and is considerably less costly than acellular dermal matrix. This study examines the use and long-term follow-up of Vicryl mesh in breast reconstruction.
  
  
  METHODS
  Vicryl mesh was used in 46 breast reconstructions (38 patients; 35 immediate and three delayed). The mesh was used along the inframammary fold to maintain position of the inferior pectoral edge, and/or along the lateral border to maintain expander position and prevent lateral migration. Eight breasts received adjuvant radiation therapy.
  
  
  RESULTS
  Mean follow-up at the time of review was 43 months. In the nonirradiated group (38 breasts), there was one postoperative infection (2.6 percent), which required expander removal. In the irradiated group, there were three complications requiring expander removal (37.5 percent): two infections and one device exposure after irradiation. Significant malposition was not observed in any breast where Vicryl mesh was used, and no visible mesh remained at the time of implant placement. The incidence of symptomatic capsular contracture in nonirradiated breasts was 3.2 percent. At latest follow-up, nonirradiated breasts had an average Baker capsule grade of 1.1, compared with 1.5 in the irradiated group.
  
  
  CONCLUSIONS
  Vicryl mesh is an effective alternative to acellular dermal matrix in nonirradiated breast reconstruction and is available at approximately one-twentieth the cost. Acellular dermal matrix or full muscle coverage may be preferable in irradiated reconstructions.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Johnson City, Tenn.; and Bradenton, Fla. From the Division of Plastic Surgery, East Tennessee State University; and Lakewood Ranch Plastic Surgery.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Haynes
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Kreithen
mesh_terms: D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011098:Polyglactin 910 / Q000494:pharmacology*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011475:Prosthesis Failure; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D013526:Surgical Mesh; D013997:Time Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D014481:United States
chemical_list: D011098:Polyglactin 910