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Biologic Meshes in Breast Reconstruction

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Breast Reconstruction

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Abstract

Implant-based breast reconstruction (IBBR) is the most commonly used surgical technique after mastectomy. The expander-implant (EI) approach may present disadvantages such as pain during the expansion phase and a flat unnatural look of the breast. On the other hand, the direct-to-implant (DTI) single-staged approach leaves the inferior pole of the implant covered by the mastectomy flap only, putting it at risk of exposure in case of flap necrosis or infection. With both approaches, it is hard to control the position of the inframammary fold (IMF), avoid animation deformity and implant displacement, and achieve a natural-looking ptosis of the reconstructed breast.

The introduction of acellular dermal matrices (ADMs) in the clinical practice probably represents the greatest advance in breast reconstruction in the last decade. Biologic meshes can be subdivided in human-derived acellular dermal matrices (hADM) and xenografts, derived from nonhuman sources (porcine, bovine, equine). ADMs have several applications in both primary and revisional implant-based breast reconstruction such as expanding the submuscular pocket to enhance both EI and DTI breast reconstruction, correct symmastia, camouflage surface irregularities and rippling, correct inframammary pole malposition, and provide interface when performing capsulotomies or capsulectomy for recurrent capsular contracture.

The purpose of this chapter is to outline the indications, patient selection, surgical techniques, and possible complications deriving from the use of biologic meshes in breast reconstruction.

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  1. Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy

    Paolo Persichetti, Barbara Cagli & Rosa Salzillo

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  2. Barbara Cagli
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Correspondence to Paolo Persichetti .

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  1. Hospital Italiano de Buenos Aires, Capital Federal, Buenos Aires, Argentina

    Horacio F. Mayer

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Persichetti, P., Cagli, B., Salzillo, R. (2020). Biologic Meshes in Breast Reconstruction. In: Mayer, H. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-34603-4_5

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