Three Years Experience with Absorbable Mesh in Single-Stage Breast Reconstruction: A Cost-Effective Alternative
William G. Austen, Jr., MD, Robert Neumann, MD, Oren Tessler, MD, Daniel Maman, MD, Barbara L. Smith, MD, PhD, Heather R. Faulkner, MD, MPH.
Massachusetts General Hospital, Boston, MA, USA.
The current circumstances of US healthcare mandate elimination of unnecessary costs while increasing efficiency in patient care. Traditional implant-based breast reconstruction encompasses multiple stages and using acellular dermal matrix (ADM); both increase cost. The senior author (WGA) has used absorbable knitted mesh (Vicryl™ - polyglactin 910) as an inferior pole sling in single-stage direct-to-implant (DTI) breast reconstruction since 2011. We report 3 year outcomes and cost savings data using this material.
All patients who underwent DTI with mesh since 2011 were entered retrospectively into our database. Information captured includes demographics, intra-operative/post-operative data, cancer-related therapies, and comorbidities.
DTI was performed on 149 patients (54 unilateral, 95 bilateral; 244 breasts). Mean age was 51.9 years. Mean post-op time was 21.1 months. Prophylactic mastectomy rate was 38.5%. Percentage of irradiated breasts (pre- or post-operative) was 28.7%. Infection rate was 1.6% (n = 4 breasts). Five implants (2%) were exposed (3 were salvaged). Seven implants (2.9%) were removed. Nine breasts (3.7%) had capsular contracture (5 had additional surgery: 2 flaps, 3 capsulotomy/capsulectomy with implant exchange). Capsular contracture was significantly greater in irradiated breasts (10% vs 1.1%, p = 0.0008). Material cost savings using mesh over ADM was above \,000.
We have 3 years experience using absorbable mesh for DTI. We maintain a low complication rate, excellent aesthetic outcomes, and have achieved substantial efficiency and cost reduction.
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