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



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.


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.


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 < 0.001).


Our novel method of donor-site closure with semi-absorbable mesh in a subfascial position for reinforcement of the anterior rectus fascia on the DIEP donor site is safe. It has no negative impact on surgical site complications and patient-reported outcomes, while reducing the incidence of hernias on the donor-site in DIEP flap breast reconstruction.

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We acknowledge the effort from Clara Neuss in revising the manuscript.


There was no external funding source for this study.

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All authors made substantial contributions. DKF designed the study. DKF, LS and LCS acquired all data. SF, CH, UK and YD interpreted and analyzed the data. DKF, LS and LCS drafted the article. SF, CH, UK and YD critically revised the manuscript. All authors gave their final approval of the version to be submitted.

Corresponding author

Correspondence to D. Kotsougiani-Fischer.

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Ethical Approval

This study was approved by the local ethical committee [837.516.16 (10834)] and a retrospective cohort study was designed following the ethical standards laid down in the World Medical Association Declaration of Helsinki (June 1964) and its later amendments.

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Informed consent was obtained from all study participants.

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Siegwart, L.C., Sieber, L., Fischer, S. et al. The Use of Semi-Absorbable Mesh and its Impact on Donor-Site Morbidity and Patient-Reported Outcomes in DIEP Flap Breast Reconstruction. Aesth Plast Surg (2021).

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  • DIEP
  • Breast reconstruction
  • Mesh
  • Donor-site morbidity
  • Hernia