Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh

Background: Biological and synthetic meshes may improve the outcomes of immediate implant-based breast reconstruction (IBBR) by facilitating single-stage procedures and improving cosmesis. Supporting evidence, however, is limited. The aim of this study was to explore the impact of biological and synthetic mesh on the patient-reported outcomes (PROs) of IBBR 18 months following surgery. Methods: Consecutive women undergoing immediate IBBR between February 2014 and June 2016 were recruited to the study. Demographic, operative, oncological and 3-month complication data were collected, and patients received validated BREAST-Q questionnaires at 18-months. The impact of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically relevant confounders and including a random-effect to account for clustering by centre. Results: 1470 participants consented to receive the questionnaire and 891 completed it. Of these, 67 patients underwent two-stage submuscular reconstructions. 764 patients received submuscular reconstructions with biological mesh (n=495), synthetic mesh (n=95) or dermal sling (n=174). 14 patients had prepectoral reconstructions. Compared with two-stage submuscular reconstructions, no differences in PROs were seen in biological or synthetic mesh-assisted or dermal-sling procedures (p>0.05). However, patients receiving prepectoral IBBR reported better satisfaction with breasts (adjusted mean difference= +6.63, 95% confidence interval [1.65–11.61], p=0.009). PROs were similar to the National Mastectomy and Breast Reconstruction Audit 2008/9 cohort, which included two-stage submuscular procedures only. Conclusion: This study found no difference in PROs of subpectoral-IBBR with or without biological or synthetic mesh but provides early data to suggest improved satisfaction with breasts following prepectoral reconstruction. Robust evaluation is now required before this approach is adopted as standard practice.