Synthetic Mesh Use in Implant-Based Breast Reconstruction after Mastectomy: What Determines the Surgical Outcome?

Synthetic mesh is frequently used in immediate implant-based breast reconstruction following skin-sparing or nipple-sparing mastectomy to enable immediate reconstruction, though concerns persist regarding associated complications.

We conducted a retrospective single-center registry study involving 220 consecutive patients, of whom 123 (55.9%) received synthetic mesh: 92 with semi-resorbable (Seragyn®) and 31 with non-resorbable (TiLOOP®) mesh.

Postoperative complications occurred in 90 patients (40.9%), with seroma formation as the primary contributor to morbidity (58.8%). No significant difference in overall complication rates was found between patients with or without mesh (44.7% vs. 36.1%, p = 0.196) or between mesh types (44.6% vs. 45.2%, p = 0.954). Rates of revision surgery, infection, wound healing disorders, capsular contracture, and seroma did not differ significantly between groups (all p > 0.05). Multivariable analysis identified obesity (BMI ≥30 kg/m²) as a significant predictor of both overall complications and seroma. Radiation therapy increased the risk of revision surgery. Age, smoking status, surgical laterality, implant location, and primary systemic therapy had no significant impact.

The use of synthetic mesh, whether semi-resorbable or non-resorbable, does not significantly affect the risk of postoperative complications in breast reconstruction after skin-sparing mastectomy or nipple-sparing mastectomy (NSM). Therefore, surgical planning should prioritize oncologic safety, esthetic outcomes, and individual patient factors. Shared decision-making remains essential in choosing the optimal reconstructive approach.