Immediate Breast cancer reconstruction- does mesh or ADM increase risk?

Posted on May 16, 2023

Quick blog, but the idea of doing immediate breast cancer reconstruction with an implant (not a two stage reconstruction with a tissue expander and then an implant) is becoming more popular. Commonly when a single stage is done, the implant is now being placed in front of the pectoral muscle, and they wrap it with mesh or ADM (acellular dermal matrix like alloderm- human- or strattice- xenograft). The question is- what is the complication rate?

This study published in the Plastic and Reconstructive Surgery Journal April 2023 “Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network Meta Analysis.”  This looked at human ADM, Xenograft ADM and mesh. All surgeries were done with placement of the implant under the pectoral muscle as part of an immediate implant-based reconstruction.

This was a meta analysis of the literature. They found 31 applicable studies.

They conclude that Human ADM had higher infection and seroma complications. Xenograft ADM and mesh were comparable, though Xenograft ADM is much more expensive than mesh.

My thoughts?

Immediate reconstruction with an implant is growing. The current trend seems to be to wrap the implant in mesh and put in front of the muscle. This study though focused on behind the muscle implant placement.

It is a meta analysis study, which is not the best to make decisions. The best study is a prospective controlled trial. So this was interesting, but other than the clear issue it seemed to find with human ADM, it did not help me suss out what to do. Mesh? (which is much cheaper) In front on muscle? (which is the current trend but not commented on here.)

Keep the studies coming. It is good to stratify risk.