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Biologic versus synthetic meshes in irradiated implant-based breast reconstruction: A systematic review and
Dora L Fedorcsak1, Levente Doleviczenyi2, Lorinc Frivaldszky3
1Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Background:
Implant-based breast reconstruction (IBBR) is widely used after mastectomy and often involves incorporation of biologic or synthetic meshes. In patients receiving radiation therapy, complication rates can be up to twice as high in IBBR; however, the comparative safety of mesh types in this setting remains unclear. This meta-analysis aimed to evaluate outcomes of biologic versus synthetic mesh use in irradiated patients who underwent IBBR.
Methods:
We searched the MEDLINE, Embase, and CENTRAL databases through November 14, 2024. Studies were included if they reported on irradiated patients undergoing IBBR using biologic or synthetic meshes and provided outcome data on complications. The primary outcome was overall complication rate; secondary outcomes were implant loss, capsular contracture, infection, seroma, and necrosis. Univariate and multivariate random-effects meta-analyzes were conducted. Multivariate models adjusted for mesh type, implant placement (subpectoral vs. prepectoral), and radiotherapy timing (pre- vs. postoperative).
Results:
Fifty-one studies were included. The pooled complication rate was 33% (95% CI: 25-41%, p<0.001) for biologic mesh and 30% (95% CI: 13-56%, p=0.347) for synthetic mesh, with no significant difference. Subpectoral placement was associated with significantly higher odds of implant loss (OR = 2.32, 95% CI: 1.24-4.33, p=0.0086) and capsular contracture (OR = 2.91, 95% CI: 1.22-6.95, p=0.0165) compared to prepectoral placement. Preoperative radiotherapy was linked to increased implant loss (OR 1.89, 95% CI 1.21-2.94; p=0.0051). Mesh type did not significantly affect the rates of capsular contracture, implant loss, seroma, or necrosis.
Conclusion:
Biologic and synthetic meshes show comparable clinical outcomes in irradiated IBBR. Implant placement and radiotherapy timing are predictive of complications and support a tailored approach to mesh selection based on clinical and economic considerations.
