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Splitting the Difference: Using Synthetic and Biologic Mesh to Decrease Cost in Prepectoral Immediate Implant Breast

Nolan S Karp1, Ara A Salibian1

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Plastic and Reconstructive Surgery
|February 23, 2021
PubMed
Summary
This summary is machine-generated.

This study introduces a cost-effective prepectoral breast reconstruction technique using acellular dermal matrix and absorbable mesh. The method reduces material costs while maintaining low complication rates for breast implant coverage.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Biomaterials in Medicine

Background:

  • Prepectoral breast reconstruction offers advantages over submuscular techniques but often incurs high costs due to acellular dermal matrix reliance.
  • Optimizing implant coverage in immediate breast reconstruction is crucial for minimizing morbidity and achieving aesthetic outcomes.

Purpose of the Study:

  • To describe and evaluate a novel technique for prepectoral breast reconstruction using a combination of acellular dermal matrix and synthetic absorbable mesh for anterior implant coverage.
  • To assess the safety, efficacy, and cost-effectiveness of this hybrid coverage approach in immediate implant-based breast reconstruction.

Main Methods:

  • A retrospective review of consecutive prepectoral one-stage breast reconstructions utilizing acellular dermal matrix inferolaterally and Vicryl (synthetic, absorbable mesh) superiorly.
  • Analysis of patient demographics, mastectomy and reconstruction details, reconstructive outcomes, complication rates, and material costs.

Main Results:

  • Eleven patients (21 breasts) underwent reconstruction with the hybrid technique, using large-volume implants (average 514.5 ml).
  • Low complication rates were observed, including minor infection (4.8%) and minor mastectomy flap/nipple necrosis (4.8%).
  • Significant cost savings were calculated, ranging from $3415 (unilateral) to $6830 (bilateral) compared to full acellular dermal matrix coverage.

Conclusions:

  • The combined use of acellular dermal matrix inferiorly and absorbable mesh superiorly is a safe and effective method for prepectoral breast reconstruction.
  • This technique offers substantial cost reduction in implant-based breast reconstruction by optimizing the use of expensive acellular dermal matrix.
  • The approach allows for precise control of the implant pocket and position, potentially improving reconstructive outcomes.