Early Use and Outcomes of Polydioxanone Mesh in Implant-based Breast Reconstruction

As the diagnosis of breast cancer has increased during the past 2 decades, so too has the number of resection procedures, including mastectomies. Of the available reconstructive options postmastectomy, implant-based breast reconstruction (IBBR) predominates. Biologic scaffolds, such as human acellular dermal matrices, are routinely used to support tissue expanders and implants. However, human acellular dermal matrices have several limitations, including high infection rates, high cost, and supply concerns. Synthetic scaffolds address some of these concerns, though they differ significantly in time to resorption. In this study, we reported data from IBBR using polydioxanone (PDO) mesh.

This prospective, multisite, observational registry study evaluated the use of PDO mesh (DuraSorb) implanted during IBBR, including 2-stage and direct-to-implant procedures. Based on the timing of PDO mesh placement, success was defined as the placement of a permanent implant or completion of reconstruction in the absence of major adverse events requiring expander or permanent implant removal. Adverse events were also recorded.

Procedural success with PDO mesh was 97.2% (n = 71), 96.9% (n = 32), and 75% (n = 4) when implanted at the time of the tissue expander, permanent implant placement, and direct-to-implant procedures, respectively. The incidence of infection, skin flap necrosis, and seroma requiring drainage was 6.5%, 12.2%, and 10.3% of breasts, respectively. No medical complications (deep vein thrombosis, pulmonary embolism, cardiac events, acute renal failure, difficulty weaning from the ventilator) were reported.

IBBR using PDO mesh demonstrated favorable safety and performance outcomes in this observational study.