title: Risks and benefits of using an absorbable mesh in one-stage immediate breast reconstruction: a comparative study.
abstract: BACKGROUND
  Complete implant coverage by pectoralis major muscle in immediate breast reconstruction prevents implant exposure but restricts implant volume, increases the risk of a high-riding implant, and prevents natural ptosis. The authors hypothesized that extension of the subpectoral pocket with Vicryl mesh may produce more satisfactory results. The safety and efficiency of this technique were assessed by comparing complication rates and clinical results of the two reconstruction techniques: with and without mesh.
  
  
  METHODS
  The authors reviewed 161 immediate breast reconstructions in 139 patients from 2002 to 2010. A complete submuscular pocket was performed in 46 breasts and a partial submuscular pocket with Vicryl mesh extension was performed in 115 breasts. Complications, surgical revisions rates, implant size, and contralateral breast procedures were compared between the two groups.
  
  
  RESULTS
  Early and late surgical revisions were similar between the mesh and nonmesh groups (11.6 percent versus 4.3 percent at 90 days, p = 0.09; and 34.3 percent versus 41.4 percent at 5 years, p = 0.41). There were fewer revisions for implant malposition in the mesh group (8.9 percent versus 21.7 percent, p = 0.05). Patients with mesh could have a larger implant in comparison with those without mesh (329 g versus 284 g, p = 0.01) and had fewer contralateral mastopexies (12 percent versus 30 percent, p = 0.01).
  
  
  CONCLUSIONS
  Larger implants and perhaps better control of implant position were possible using the Vicryl mesh extension without increasing complications. Because the mesh technique also recreates a slightly ptotic breast, fewer contralateral mastopexies were needed. The Vicryl mesh extension is a low-cost alternative to biological matrices or tissue expanders.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Geneva, Switzerland From the Division of Plastic, Reconstructive and Aesthetic Surgery, the Division of Epidemiology, and the Division of Gynecology, Senology and Surgical Gynecological Oncology, Geneva University Hospitals; and Medical School, University of Geneva.
authors.forename: Oanna Meyer
authors.initials: OM
authors.lastname: Ganz
authors.forename: Mickaël
authors.initials: M
authors.lastname: Tobalem
authors.forename: Thomas
authors.initials: T
authors.lastname: Perneger
authors.forename: Thanh
authors.initials: T
authors.lastname: Lam
authors.forename: Ali
authors.initials: A
authors.lastname: Modarressi
authors.forename: Badwi
authors.initials: B
authors.lastname: Elias
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pittet
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011098:Polyglactin 910; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013557:Switzerland / Q000453:epidemiology
chemical_list: D011098:Polyglactin 910