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Evaluation of subfascial polypropylene mesh for abdominal wall repair after microsurgical breast reconstruction
Casey T. Kraft, MD, Bianca J. Molina, MD, & Roman Skoracki, MD
Ohio State University
2019-01-26
Presenter: Casey T. Kraft, MD
Affidavit:
This presentation has been approved by the program director for presentation at OVSPS, and has not been presented at any other meetings or published in any journals. All work is the work of the listed authors.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Abdominal wall morbidity after microsurgical breast reconstruction is an important consideration for patients and surgeons. Previous studies are limited by multiple mesh locations or types. In this study, we evaluate specifically subfascial polypropylene mesh placement to determine a more definitive complication rate and basis for objective comparison.
Methods: A retrospective review was performed for patients undergoing microsurgical breast reconstruction at our institution by three surgeons from 2015-2018. All patients with subfascial placement of polypropylene mesh were included. Patient demographics, medical co-morbidities, type of reconstruction, and post-operative abdominal wall complications were recorded.
Results: A total of 114 flaps were performed on 81 patients that met inclusion criteria. Of these, 48 were DIEP flaps (42%), 43 were MS-2 TRAM flaps (37.8%), 20 were MS-1 TRAM flaps (17.5%), and 3 were free TRAM flaps (2.6%). Average follow up was 392 days (range 29-1191). Average BMI was 30.7. No patients developed hernias. Two patients (2.5%) complained of post-operative bulges, neither of which required operative treatment. Two patients experienced superficial abdominal wall infection, one of which required admission and IV antibiotics. Ten patients (12.3%) had abdominal incision dehiscence, three of which required operative intervention. There were no cases of mesh exposure, contamination, or removal.
Conclusion: Polypropylene mesh is safe and effective, with subfascial placement resulting in low morbidity and low rates of bulge/hernia formation after microsurgical breast reconstruction. Consideration should be given to using polypropylene mesh for fascial repairs after microsurgical breast reconstruction, particularly in high risk populations.
