Support or Simplicity: Evaluating Mesh Use in Two-Stage Prepectoral Breast Reconstruction

The routine use of surgical mesh in prepectoral two-stage breast reconstruction has increased despite limited high-level evidence supporting its necessity. The purpose of this study was to evaluate whether mesh use impacts postoperative complications, reconstructive failure, or secondary revision rates.

A multicenter retrospective cohort study was conducted of patients undergoing immediate prepectoral two-stage breast reconstruction from 2016 to 2025, stratified by use of mesh at the time of expander placement. Patients undergoing delayed reconstruction or concurrent/planned autologous reconstruction were excluded. Logistic regression models assessed predictors of (1) postoperative complication, (2) reconstructive failure, and (2) secondary revision.

The final sample included 1,592 reconstructions in 948 patients, of which 84.4% used mesh. Complications occurred more frequently in reconstructions with mesh (18.2% vs. 12.9%, p=0.039), primarily due to higher infection rates (8.7% vs. 4.8%, p=0.039). On multivariable analysis, mesh use was associated with increased odds of complication (OR: 1.574, 95% CI: 1.047-2.437, p=0.035) but not reconstructive failure (OR: 1.222, 95% CI: 0.684-2.181, p=0.499). Secondary revision rates did not differ significantly between the two cohorts (21.5% vs. 24.4%, p=0.333) and mesh use was not found to be protective of secondary revision (OR: 1.165, 95% CI: 0.821-1.653, p=0.392).

In prepectoral two-stage breast reconstruction, mesh use was associated with increased postoperative complications, particularly infection, and did not confer a reduction in reconstructive failure or secondary revision rates. While mesh is a useful adjunctive tool commonly used in breast reconstruction, its routine incorporation in two-stage reconstruction is costly and may not be necessary.