Revisiting low complications of VICRYL mesh in breast reconstruction: Insights from an updated systematic review

Abstract

Background: Alloplastic breast reconstruction continues to be the most prevalent breast reconstruction performed in the United States. Plastic surgeons are challenged to recreate the breast footprint after the ablative surgeon's mastectomy. Mesh augmentation has emerged as a valuable tool in controlling implant migration. Several soft tissue support breast meshes have been introduced, each characterized by a different risk profile, cost, and associated complications. Objectives: This manuscript presents a comprehensive systematic review, with updated data over the last decade, of the use of a resorbable and less costly VICRYL (Ethicon, Somerville, NJ, USA) mesh in breast reconstruction after mastectomy. Methods: The authors conducted a systematic review of the use of VICRYL mesh in breast reconstruction using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors queried five databases. Data was collected using a standardized form and underwent review using set inclusion and exclusion criteria. The primary outcome variable was reconstructive failure, with secondary outcomes including seroma, hematoma, skin necrosis, and infection. Results: A total of 693 articles were found after the multi database search. Forty articles met inclusion criteria. Following full text review, six articles analyzing 511patients were included. VICRYL mesh was utilized in 711 breast reconstructions, of which 5% were complicated by reconstructive failure (confidence interval (CI): 4.75–5.25%); 1.6% by seroma (CI: 1.53–1.67%); 3.33% by infection (CI: 3.14–3.52%); 1.83% by hematoma (CI: 1.71–1.95%); and 6.33% by skin necrosis (CI: 6.03–6.63%). Conclusion: VICRYL mesh repeatedly demonstrates low reconstructive failure in breast reconstruction with an acceptable complication profile.

Keywords

• VICRYL mesh
• Breast reconstruction
• Direct to implant
• Acellular dermal matrix