Mesh-free prepectoral breast reconstruction: a safe and effective alternative

Prepectoral breast reconstruction (PBR) offers several advantages, including reduced postoperative pain, fewer animation deformities, shorter operative time, better aesthetic outcomes, and greater patient comfort, and has gradually become an important option for post-mastectomy reconstruction. However, most current prepectoral reconstruction procedures still rely on mesh (such as acellular dermal matrix [ADM] or synthetic mesh) to enhance soft tissue coverage and reduce the risk of implant-related complications, such as capsular contracture and implant exposure. The use of mesh, however, also introduces additional concerns, including high cost, risk of infection, and foreign body reactions. Therefore, this study aims to compare two surgical approaches-prepectoral breast reconstruction with mesh (PBR with mesh) and prepectoral breast reconstruction without mesh (PBR without mesh)-in breast cancer patients, evaluating their clinical outcomes and aesthetic results, and to summarize the advantages of mesh-free prepectoral breast reconstruction.

This study retrospectively analyzed the clinical data of 246 patients who underwent PBR between June 2023 and December 2024. Patients were divided into two groups according to the surgical approach: the mesh-free group (128 cases, including 26 who received postoperative radiotherapy) and the mesh group (118 cases, including 25 who received postoperative radiotherapy). Baseline characteristics, perioperative indicators (such as operative time and blood loss), and postoperative complications (including infection, capsular contracture, and implant loss) were thoroughly evaluated and subjected to cost analysis. A subgroup analysis was performed specifically for the 51 patients who received postoperative radiotherapy (26 in the mesh-free group and 25 in the mesh group), with particular focus on comparing the incidence of capsular contracture between the two groups. In addition, the BREAST-Q questionnaire was used to systematically assess patients' postoperative quality of life and satisfaction.

Regarding major complications, no statistically significant differences were observed between the mesh-free and mesh groups: infection rate (3.13% vs. 5.08%, p=0.527), severe capsular contracture rate (2.34% vs. 4.24%, p=0.486), wound dehiscence (2.34% vs. 3.39%, p=0.713), and implant loss rate (2.34% vs. 3.39%, p=0.713) (all p>0.05). Regarding perioperative indicators, there was no statistically significant difference in intraoperative blood loss and postoperative drainage volume between the two groups. The operation time in the non-patch group was significantly shorter than that in the patch group (107.50 [95.00, 120.00] vs. 125.00 [115.00, 135.00] minutes, p<0.001) and lower hospitalization costs (42,242.36 [39,999.14, 44,628.14] RMB vs. 60,083.01 [57,592.06, 63,443.36] RMB, p<0.001). In the subgroup analysis of 51 patients who received postoperative radiotherapy, the incidence of severe capsular contracture was higher in the mesh group compared with the mesh-free group (20% vs. 7.7%), although the difference did not reach statistical significance (p=0.193). BREAST-Q results showed no significant differences between the two groups in Satisfaction with breasts (54.00 [53.00, 56.00] vs. 53.50 [52.00, 55.00], p=0.051), Psychological well-being (39.50 [38.00, 41.00] vs. 39.00 [37.00, 40.00], p=0.092), or Sexual well-being (19.00 [18.00, 20.00] vs. 19.00 [18.00, 19.25], p=0.179). However, the mesh-free group had significantly higher scores in Physical well-being: chest (31 [29, 32] vs. 27 [25, 33.25], p=0.005).

In selected patient populations, mesh-free prepectoral breast reconstruction is a safe and cost-effective option.