[Aesthetic outcomes of synthetic mesh in single-axillary approach endoscopic implant-based breast reconstruction]

To evaluate the aesthetic outcomes and safety of titanium-coated polypropylene mesh (TCPM) in immediate implant-based breast reconstruction (IBBR) following single-axillary approach endoscopic nipple-sparing mastectomy (NSM), and to provide references for the clinical application of synthetic meshes.

A retrospective analysis was conducted on 173 female patients who underwent immediate IBBR following single-axillary approach endoscopic NSM between May 2020 and June 2024. Patients were divided into a non-mesh group ( n=100) and a mesh group ( n=73) based on TCPM utilization. Baseline data, including body mass index (BMI), smoking history, alcohol consumption history, diabetes mellitus, hypertension, menstrual status, and postoperative radiotherapy, chemotherapy, and endocrine therapy, showed no significant differences between the two groups ( P>0.05), whereas patients in the mesh group were significantly older than those in the non-mesh group ( P<0.05). Postoperative complications, capsular contracture (Baker grading), prosthesis texture, aesthetic outcomes (modified Ueda score), and patient satisfaction [evaluated via the Breast Reconstruction Patient-Reported Outcome Scale (BREAST-Q)] were compared between the two groups. Ordinal logistic regression analysis was performed to identify independent factors influencing aesthetic outcomes.

All patients were successfully followed up postoperatively. The follow-up duration was 30.50 (23.24, 40.04) months in the non-mesh group and 23.95 (18.52, 32.57) months in the mesh group, with no significant difference between the two groups ( P>0.05). Regarding complications, no significant difference was observed between the two groups in the incidence of postoperative fever, upper limb lymphedema, seroma, wound dehiscence, operative site hemorrhage, or skin necrosis ( P>0.05). However, the non-mesh group demonstrated significantly better outcomes than the mesh group in Baker grading for capsular contracture, implant texture, and aesthetic ratings ( P<0.05). According to the postoperative BREAST-Q assessment, the non-mesh group scored higher in satisfaction with the reconstruction outcome and satisfaction with the surgeon ( P<0.05). No significant difference was noted between the groups regarding psychosocial well-being, sexual health, breast appearance, implant contour, satisfaction with chest recovery, or satisfaction with the medical team ( P>0.05). Univariate ordinal logistic regression analysis revealed that menstrual status, mesh usage, and postoperative radiotherapy, endocrine therapy, upper limb lymphedema were associated with breast aesthetic outcomes ( P<0.05). Multivariate ordinal logistic regression analysis further confirmed that postoperative radiotherapy and mesh usage were independent risk factors for diminished aesthetic outcomes ( P<0.05).

In immediate IBBR following single-axillary approach endoscopic NSM, omitting TCPM mesh superior aesthetic outcomes, a more natural breast texture, and a lower incidence of severe capsular contracture without increasing the risk of complications. Therefore, the routine application of TCPM in this specific surgical procedure warrants cautious consideration.