The Use of Semi-Absorbable Mesh and its Impact on Donor-Site Morbidity and Patient-Reported Outcomes in DIEP Flap Breast Reconstruction

• Published in: Aesthetic plastic surgery 2021-06, Vol.45 (3), p.907-916
• Main Authors: Siegwart, L. C., Sieber, L., Fischer, S., Diehm, Y., Hirche, C., Kneser, U., Kotsougiani-Fischer, D.
• Format: Article
• Language: English
• Subjects: Hernias; Mastectomy; Medicine; Medicine & Public Health; Morbidity; Muscle strength; Original Article; Otorhinolaryngology; Patients; Plastic Surgery; Surgical mesh; Well being
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-020-02096-0

Background This study aimed to evaluate the impact of semi-absorbable mesh on donor-site morbidity and patient-reported outcomes in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods We conducted a retrospective cohort study of all patients who had DIEP flap breast reconstruction in our department from July 2007 to March 2019. Patients were invited to a comparative follow-up visit and grouped according to donor-site closure: primary fascial closure (the no-mesh group) and fascial reinforcement with semi-absorbable mesh in a subfascial position (the mesh group). The primary outcome of interest was donor-site morbidity, including bulging, hernia formation and rectus abdominis muscle strength. We also surveyed, surgical site complications and patient-reported outcomes using Patient and Observer Scar Assessment Scale v2.0 and BREAST-Q © version 2.0. Results A total of 191 patients had received DIEP flap breast reconstruction. Eighty-five patients (44.5%) with 108 DIEP flaps (53 patients in the mesh group and 32 patients in the no-mesh group) were included in the study. The mean BMI of the patients was significantly higher in the mesh group (mesh group, 26.9 vs. no-mesh group, 25.0, with p  = 0.03). The incidence of hernia was significantly reduced in the mesh group (mesh group, 2.8% vs. no-mesh group, 13.5%, with p  = 0.03). The incidence of bulging and the extent of rectus abdominis muscle strength were similar for both groups. Operative surgical site complications were reduced in the mesh group (mesh group, 7.5% vs. no-mesh group, 18.8%). There was no difference in patients’ physical well-being and satisfaction with the donor site between groups. Patient-reported scar outcome was significantly better in the no-mesh group ( p