Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review.
BACKGROUND
Mastectomy and breast reconstruction are essential parts of the treatment of breast cancer. Acellular dermal matrices (ADMs) have been used for the reconstruction of the lower pole due to many advantages; however, its cost is seen as a major drawback in this era of concern for the allocation of health-care funds. Recently, polyglactin 910 (Vicryl; Ethicon, Somerville, NJ, USA) mesh has been published as an alternative. We assessed the published literature, in particular investigating for studies that compare Vicryl mesh with ADM.


METHODS
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searched databases included Medline/PubMed, Cochrane Reviews, Embase, Web of Science, ClinicalTrials, and SCOPUS. Search criteria were as follows: (1) reporting of clinical data using Vicryl mesh in breast reconstruction, (2) reporting of original data, and (3) outcome of interest reported.


RESULTS
We retrieved 290 de-duplicated articles. After title and abstract screening, we dismissed 258 articles, and thus full text was reviewed for 32 articles; only three retrospective articles met inclusion criteria. The total population included 112 patients and 156 breasts. The reported incidence of complications was as follows: infection 2.6% (confidence interval (CI): 0.7-6.6%), reconstruction failure 3.2% (CI: 1.0-7%), and seroma 1.3% (CI: 0.2-4.6%). A seven- to 12-fold cost difference was reported. Follow-up length ranged from 1.2 to 3.6 years. No studies directly compared Vicryl mesh with ADM.


CONCLUSIONS
Although the evidence is limited, polyglactin 910 (Vicryl) mesh for immediate breast reconstruction appears to be a potentially safe, effective, and less expensive alternative to ADM. Prospective studies are needed to further compare mesh with ADM.
Department of Plastic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, USA.
Nelson
N
Rodriguez-Unda
Department of Plastic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, USA.
Stephanie
S
Leiva
Department of Plastic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, USA.
Hsu-Tang
HT
Cheng
William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Stella M
SM
Seal
Department of Plastic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, USA.
Carisa M
CM
Cooney
Department of Plastic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, USA. Electronic address: gedge@jhmi.edu.
Gedge D
GD
Rosson
D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D011098:Polyglactin 910; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011474:Prosthesis Design; D013526:Surgical Mesh
D011098:Polyglactin 910
Breast reconstruction; Implant tissue expander; Mastectomy; Systematic review; Vicryl mesh