Abstract
Background and Objectives: Implant-based breast reconstruction following subcutaneous mastectomy is widely performed; however, the optimal strategy for implant support remains controversial. Absorbable synthetic meshes have emerged as lower-cost alternatives to acellular dermal matrix (ADM), yet their clinical and economic value remains incompletely defined. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. Studies evaluating implant-based breast reconstruction with absorbable synthetic meshes, ADM, or without mesh were included. Outcomes of interest comprised postoperative complications, operative time, material costs, aesthetic outcomes, and patient-reported satisfaction. Methodological quality and risk of bias were assessed using design-appropriate appraisal tools. Results: Absorbable synthetic meshes were associated with low complication rates, including infection (3–8%), seroma (0–5%), hematoma (1–4%), skin necrosis (4–6%), and implant loss (3–6%). Compared with ADM, complication rates appeared comparable, while shorter operative times were reported in comparative studies. Material cost reductions of up to 90% were reported in comparative studies. Several studies reported favorable aesthetic outcomes and high patient satisfaction, although assessment methods were not standardized. Most included studies were retrospective or single-arm observational studies, with substantial clinical and methodological heterogeneity and an overall moderate risk of bias. Conclusions: Available evidence, derived predominantly from studies of polyglactin mesh, suggests that absorbable synthetic meshes may represent a feasible option for selected implant-based breast reconstructions, with potential advantages in terms of material costs and operative time. Evidence regarding polydioxanone mesh remains very limited, and the methodological limitations of the available studies preclude definitive conclusions.
Keywords: breast reconstruction, implant-based breast reconstruction, absorbable mesh, polyglactin, polydioxanone, prepectoral reconstruction, material costs
1. Introduction
Breast reconstruction with implants following subcutaneous mastectomy has become an integral component of modern oncologic and plastic and reconstructive surgery, significantly contributing to patients’ psychosocial well-being and overall quality of life. Over the past decade, implant-based breast reconstruction has emerged as the dominant approach in many centers worldwide, as it enables faster aesthetic outcomes, shorter operative times, and more rapid postoperative recovery compared with autologous microsurgical techniques [1,2]. Furthermore, patients undergoing implant-based reconstruction typically experience quicker return to daily activities and reduced perioperative burden.
Traditionally, implant-based breast reconstruction following subcutaneous mastectomy has most commonly been performed in the subpectoral plane. While this approach effectively restores breast volume and contour, it is associated with several clinically relevant drawbacks. Patients often experience postoperative pain, restricted upper limb mobility for several months, delayed rehabilitation, and functional limitations [3]. Additionally, during the early postoperative period, before the formation of a stabilizing fibrous capsule, the implant may lack adequate support within the created pocket. This may result in implant rotation or displacement, leading to suboptimal positioning.
Moreover, as the pectoralis major muscle adheres to the developing capsule, muscle contraction can cause implant displacement, resulting in breast animation deformity. This phenomenon represents a significant functional and aesthetic concern, particularly in physically active patients.
To overcome these limitations and reduce both functional impairment and aesthetic complications, the use of synthetic meshes has been increasingly adopted. Both absorbable and non-absorbable meshes allow for implant placement in a prepectoral (subcutaneous) position. These materials provide structural support, help maintain implant position—particularly in the lower pole of the breast—and may reduce complications such as seroma formation, skin necrosis, and implant malposition in appropriately selected patients [3].
Various adjunctive materials have been introduced in clinical practice, including permanent synthetic meshes and absorbable meshes. The latter, such as polyglactin (Vicryl™) and polydioxanone (PDO), provide temporary mechanical support during the early phases of wound healing and are subsequently fully resorbed, thereby avoiding long-term foreign body presence [4,5].
In addition, implant-based breast reconstruction without mesh remains a viable option in carefully selected patients. However, current evidence remains heterogeneous, and large-scale randomized controlled trials are lacking. Consequently, it is still unclear whether absorbable meshes provide a significant long-term advantage compared with mesh-free reconstruction or reconstruction using acellular dermal matrix (ADM).
Within the expanding biomaterial landscape, absorbable synthetic meshes represent a distinct category of temporary structural scaffolds. Unlike emerging injectable or flowable matrices, which are designed primarily for soft-tissue augmentation or regenerative applications, absorbable sheet-form meshes provide temporary mechanical support during the early postoperative period. Their clinical relevance may therefore be particularly important in selected immediate implant-based reconstructions in which temporary implant stabilization, avoidance of permanent synthetic material, and reduced material costs are desired.
Therefore, the aim of this systematic review was to evaluate the outcomes of implant-based breast reconstruction following subcutaneous mastectomy using absorbable synthetic meshes and to compare them with mesh-free reconstruction and acellular dermal matrix (ADM)-assisted reconstruction, focusing on surgical, aesthetic, quality-of-life, and economic outcomes.
2. Materials and Methods
2.1. Literature Search Strategy
This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement [6]. The PRISMA 2020 flow diagram is presented in Figure 1, and the completed PRISMA 2020 checklist is provided as Supplementary Material. This review was not prospectively registered.
Figure 1.
PRISMA 2020 flow diagram illustrating the study selection process.
A comprehensive search of the literature was performed using PubMed, Scopus, and Web of Science databases from inception to July 2025. Only studies published in English were included.
The following keywords and their combinations were used: “polyglactin mesh,” “Vicryl mesh,” “polydioxanone mesh,” “PDO mesh,” “prepectoral implant breast reconstruction,” “subpectoral reconstruction,” “immediate breast reconstruction,” and “mesh-free reconstruction.”
In addition, the reference lists of relevant studies were manually reviewed. Recent issues of leading journals in the field, including Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive & Aesthetic Surgery, Annals of Plastic Surgery, and Breast Cancer Research and Treatment, were also screened to identify additional eligible studies.
2.2. Study Selection
The initial search identified 142 studies (PubMed n = 58, Scopus n = 47, Web of Science n = 37). After removal of duplicates (n = 29), 113 studies remained for screening based on titles and abstracts.
During the screening process, 71 studies were excluded due to irrelevance to the research topic or failure to meet the inclusion criteria. A total of 42 full-text articles were assessed for eligibility, of which 31 were excluded due to insufficient data, inappropriate study populations, or methodological limitations.
Ultimately, 11 studies were included in the final qualitative analysis.
2.3. Inclusion Criteria
Studies were included if they met the following criteria:
Prospective and retrospective clinical studies evaluating implant-based breast reconstruction using absorbable synthetic meshes, acellular dermal matrix (ADM), or mesh-free reconstruction were eligible for inclusion.
Patients undergoing subcutaneous mastectomy followed by immediate unilateral or bilateral implant-based breast reconstruction.
Explicit use of absorbable polyglactin or polydioxanone mesh, or comparison with mesh-free reconstruction or reconstruction using acellular dermal matrix (ADM).
Reported clinical outcomes, including rates of infection, seroma, skin necrosis, capsular contracture, implant loss, or reoperation, as well as aesthetic outcomes and quality-of-life measures.
2.4. Exclusion Criteria
Studies were excluded if they met any of the following criteria:
Animal or in vitro studies.
Studies focusing exclusively on aesthetic breast augmentation unrelated to oncologic reconstruction, except those describing material properties.
Studies without full-text availability or those providing insufficient outcome data.
2.5. Data Extraction and Analysis
Data were extracted from each included study, including publication year, authors, study design, number of patients, type of reconstruction (subpectoral or prepectoral), type of mesh used, complication rates (including implant loss, reoperation, capsular contracture), aesthetic outcomes, patient-reported quality-of-life measures, and economic data.
Two reviewers independently performed data extraction to ensure consistency and reduce bias.
Due to the heterogeneity of included studies in terms of surgical techniques, patient selection, outcome measures, and follow-up duration, quantitative meta-analysis was not feasible. Therefore, a narrative synthesis was performed to summarize clinical, aesthetic, and economic outcomes.
3. Results
3.1. Material Characteristics and Resorption Profiles
Polyglactin (Vicryl™, PG910) is a braided copolymer composed of glycolide and lactide, providing mechanical support for approximately 2–3 weeks and gradually losing tensile strength over 4–6 weeks, with complete resorption occurring within 8–12 weeks [4,5]. Polydioxanone (PDO) is a monofilament material with a longer resorption time of approximately 6–7 months, allowing prolonged implant stabilization, particularly in patients with thinner, soft tissue coverage [4,5]. Both materials are fully absorbable and are associated with a reduced risk of long-term foreign body reaction compared with non-absorbable meshes.
Eleven primary clinical studies evaluating implant-based breast reconstruction using absorbable synthetic meshes, acellular dermal matrix (ADM), or mesh-free techniques were included in the clinical outcomes analysis. Together, these studies comprised 549 patients (698 breasts). The characteristics of the included studies are summarized in Table 1.
Table 1.
Characteristics of the included primary clinical studies.
| Study | Plane | Mesh Type | Patients | Breasts | Follow-Up |
|---|---|---|---|---|---|
| Ganz et al., 2015 [7] | Submuscular and partial submuscular | No mesh | 40 | 46 | 3 months |
| Ganz et al., 2015 [7] | Submuscular and partial submuscular | Vicryl (Polyglactin 910) | 97 | 112 | 3 months |
| Vohra et al., 2024 [8] | Prepectoral | Vicryl (Polyglactin 910) | 28 | 32 | 12 months |
| Mookerjee et al., 2023 [9] | Prepectoral | Vicryl (Polyglactin 910) | 12 | 23 | 3 months |
| Mookerjee et al., 2023 [9] | Prepectoral | ADM | 34 | 55 | 3 months |
| Qui et al., 2022 [10] | Prepectoral | PDO (Polydioxanone) | 7 | 14 | 9 months |
| Hajiesmaeili et al., 2024 [11] | Prepectoral | No mesh | 49 | 60 | 6 months |
| Hajiesmaeili et al., 2024 [11] | Prepectoral | ADM | 52 | 60 | 6 months |
| Tessler et al., 2014 [12] | Submuscular | Vicryl (Polyglactin 910) | 50 | 76 | 1,2 years |
| Haynes et al., 2014 [13] | Prepectoral | Vicryl (Polyglactin 910) | 38 | 46 | 3,6 years |
| Gunnarsson et al., 2018 [14] | Prepectoral | Vicryl (Polyglactin 910) | 27 | 47 | 11 months |
| Hashimoto et al., 2017 [15] | Prepectoral | Vicryl (Polyglactin 910) | 80 | 81 | NR |
| Kobraei et al., 2016 [16] | Prepectoral | Vicryl (Polyglactin 910) | 13 | 23 | NR |
| Engel et al., 2013 [17] | Submuscular | No mesh | 22 | 23 | 42 months |
The postoperative clinical outcomes reported in the included studies are summarized in Table 2. Owing to differences in study design, patient characteristics, and outcome definitions, complication rates are presented as reported in the original publications.
Table 2.
Postoperative clinical outcomes of the included primary clinical studies.
| Study | Mesh Type | Overall | Infection | Hematoma | Seroma | Implant Failure | Wound Dehiscence | Necrosis | RBS | Malposition | Contracture |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ganz et al., 2015 [7] | No mesh | 19 (41.3%) | 1 (2.2%) | 0 | 0 | 4 (8.7%) | 1 (2.2%) | 0 | 0 | 10 (21.7%) | 3 (6.5%) |
| Ganz et al., 2015 [7] | Vicryl | 38 (33.9%) | 3 (2.7%) | 1 (0.9%) | 0 | 7 (6.3%) | 9 (8.0%) | 0 | 0 | 10 (8.9%) | 12 (10.7%) |
| Vohra et al., 2024 [8] | Vicryl | 4 (12.5%) | 0 | 0 | 1 (3.1%) | 1 (3.1%) | 1 (3.1%) | 1 (3.1%) | 0 | 0 | 0 |
| Mookerjee et al., 2023 [9] | Vicryl | 4 (17.4%) | 2 (8.7%) | 1 (4.3%) | 0 | 0 | 0 | 1 (4.3%) | 0 | 0 | 0 |
| Mookerjee et al., 2023 [9] | ADM | 20 (36.4%) | 2 (3.6%) | 3 (5.5%) | 7 (12.7%) | 0 | 6 (10.9%) | 2 (3.6%) | 0 | 0 | 0 |
| Qui et al., 2022 [10] | PDO | 1 (7.1%) | 1 (7.1%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Hajiesmaeili et al., 2024 [11] | No mesh | 8 (13.3%) | 0 | 1 (1.6%) | 3 (5%) | 2 (3.3%) | 1 (1.6%) | 1 (1.6%) | 0 | 0 | 0 |
| Hajiesmaeili et al., 2024 [11] | ADM | 9 (15%) | 0 | 2 (3.3%) | 3 (5%) | 2 (3.3%) | 1 (1.6%) | 1 (1.6%) | 1 (1.6%) | 0 | 0 |
| Tessler et al., 2014 [12] | Vicryl | 5 (6.6%) | 1 (1.3%) | 0 | 0 | 1 (1.3%) | 0 | 2 (2.6%) | 0 | 0 | 1 (1.3%) |
| Haynes et al., 2014 [13] | Vicryl | 7 (15.2%) | 3 (6.5%) | 0 | 1 (2.2%) | 1 (2.2%) | 0 | 2 (4.3%) | 0 | 0 | 0 |
| Gunnarsson et al., 2018 [14] | Vicryl | 5 (10.6%) | 1 (2.1%) | 2 (4.2%) | 0 | 0 | 1 (2.1%) | 1 (2.1%) | 0 | 0 | 0 |
| Hashimoto et al., 2017 [15] | Vicryl | 8 (10.0%) | 3 (3.75%) | 0 | 0 | 0 | 0 | 5 (6.25%) | 0 | 0 | 0 |
| Kobraei et al., 2016 [16] | Vicryl | 5 (38.6%) | 1 (7%) | 1 (7%) | 3 (23%) | 0 | 0 | 0 | 0 | 0 | 0 |
| Engel et al., 2013 [17] | No mesh | 18 (21.2%) | 2 (2.4%) | 1 (1.2%) | 0 | 1 (1.2%) | 0 | 0 | 0 | 0 | 9 (10.6%) |
3.2. Risk-of-Bias Assessment
The methodological quality of the included clinical studies was variable (Table 3). Comparative cohort studies generally demonstrated adequate cohort selection and outcome ascertainment; however, residual confounding remained a concern because adjustment for differences in patient characteristics and treatment-related factors was limited. Most of the remaining studies were single-arm observational case series and were generally adequate in terms of participant selection and outcome reporting, but their methodological quality was limited by the absence of comparator groups, selective patient populations, small sample sizes, and, in some studies, relatively short follow-up. Overall, most studies were considered to have a moderate risk of bias, with no study providing high-certainty comparative evidence.
Table 3.
Risk-of-bias and methodological quality assessment of the included clinical studies.
| Study | Study Design | Assessment Tool | Selection | Comparability/Confounding | Outcome Assessment/Follow-Up | Overall Appraisal |
|---|---|---|---|---|---|---|
| Ganz et al., 2015 [7] | Retrospective comparative cohort | NOS | Good | Moderate | Good | Moderate risk of bias |
| Vohra et al., 2024 [8] | Retrospective single-arm case series | JBI Case Series | Good | N/A | Good | Moderate risk of bias |
| Mookerjee et al., 2023 [9] | Retrospective comparative cohort | NOS | Good | Moderate–poor | Moderate | Moderate risk of bias |
| Qiu et al., 2022 [10] | Prospective consecutive single-arm case series | JBI Case Series | Good | N/A | Good | Low–moderate risk of bias |
| Hajiesmaeili et al., 2024 [11] | Retrospective comparative cohort | NOS | Good | Moderate–poor | Good | Moderate risk of bias |
| Tessler et al., 2014 [12] | Retrospective consecutive case series | JBI Case Series | Good | N/A | Good | Moderate risk of bias |
| Haynes & Kreithen, 2014 [13] | Observational case series based on a prospective database | JBI Case Series | Good | N/A | Good | Moderate risk of bias |
| Gunnarsson et al., 2018 [14] | Prospective case series | JBI Case Series | Moderate | N/A | Good | Moderate risk of bias |
| Hashimoto et al., 2017 [15] | Retrospective case series | JBI Case Series | Moderate | N/A | Good | Moderate risk of bias |
| Kobraei et al., 2016 [16] | Retrospective case series | JBI Case Series | Moderate | N/A | Moderate | Moderate–high risk of bias |
| Engel et al., 2013 [17] | Consecutive observational case series | JBI Case Series | Good | N/A | Good | Moderate risk of bias |
Abbreviations: NOS, Newcastle–Ottawa Scale; JBI, Joanna Briggs Institute; N/A, not applicable. Overall appraisal reflects a qualitative judgment based on the applicable domains rather than a numerical cut-off score.
3.3. Clinical Outcomes with Polyglactin Mesh
Across the included primary clinical studies, postoperative complication rates following implant-based breast reconstruction using polyglactin (Vicryl) mesh were generally low, although substantial variation was observed between studies. Reported infection rates ranged from 0% to 8.7%, hematoma from 0% to 7.0%, seroma from 0% to 3.1%, implant failure from 0% to 6.3%, wound dehiscence from 0% to 8.0%, flap necrosis from 0% to 6.3%, implant malposition from 0% to 8.9%, and capsular contracture from 0% to 10.7%. No cases of red breast syndrome were reported, while implant rippling and implant rupture were rarely observed.
3.4. Clinical Outcomes with Polydioxanone Mesh
Clinical evidence regarding polydioxanone (PDO) mesh remains limited. In the included study, postoperative outcomes were favorable, with an infection rate of 7.1% and no reported cases of hematoma, seroma, implant failure, wound dehiscence, flap necrosis, red breast syndrome, implant malposition, capsular contracture, implant rippling, or implant rupture [10].
Evidence regarding polydioxanone mesh was limited to a single study involving 7 patients and 14 reconstructed breasts. Although the reported short-term outcomes were favorable, the small sample size and absence of comparative data preclude conclusions regarding its safety, effectiveness, or equivalence to polyglactin mesh or ADM.
3.5. Clinical Outcomes with Acellular Dermal Matrix
Reconstruction using acellular dermal matrix (ADM) indicates infection rates ranging from 0% to 3.6%, hematoma from 3.3% to 5.5%, seroma from 5.0% to 12.7%, implant failure from 0% to 3.3%, wound dehiscence from 1.6% to 10.9%, and flap necrosis from 1.6% to 3.6%. Red breast syndrome was reported in up to 1.6% of cases, whereas no cases of implant malposition, capsular contracture, implant rippling, or implant rupture were reported in the included studies [9,11].
3.6. Mesh-Free Reconstruction Outcomes
Mesh-free reconstruction demonstrated infection rates ranging from 0% to 2.4%, hematoma from 0% to 1.6%, seroma from 0% to 5.0%, implant failure from 1.2% to 8.7%, wound dehiscence from 0% to 2.2%, flap necrosis from 0% to 1.6%, implant malposition from 0% to 21.7%, capsular contracture from 0% to 10.6%, and implant rupture from 0% to 5.9%. No cases of red breast syndrome or implant rippling were reported [7,11,17].
3.7. Economic Outcomes
Only one comparative clinical study directly evaluated the economic impact of absorbable mesh and ADM. Mookerjee et al. reported a substantial reduction in material costs when Vicryl mesh was used compared with ADM (USD 760 vs. USD 9033 per reconstruction), together with a shorter operative time [9].
The use of Vicryl mesh instead of acellular dermal matrices resulted in direct material cost savings of $172,112 in 10 months. From these data, direct-to-implant reconstruction with Vicryl absorbable mesh costs less than two-thirds of the total expenditures of the previous most cost-efficient technique [12].
4. Discussion
This systematic review suggests that absorbable synthetic meshes, predominantly polyglactin mesh, may represent a feasible and potentially cost-saving option for selected implant-based breast reconstructions. Evidence regarding PDO remains insufficient for firm conclusions. The available evidence suggests that absorbable meshes are associated with clinical outcomes comparable to those reported for acellular dermal matrix (ADM) and mesh-free reconstruction. However, these findings should be interpreted with caution because the available evidence is predominantly derived from retrospective and single-arm observational studies, with substantial methodological and clinical heterogeneity and an overall moderate risk of bias [7,8,9,10,11,12,13,14,15,16,17].
4.1. Complication Profile
Across the included studies, polyglactin mesh was associated with relatively low rates of postoperative complications. Seroma formation ranged from approximately 1% to 5% and was typically self-limiting, rarely requiring surgical intervention [7,8,9]. Reported rates of skin necrosis (4–8%) and infection (2–5%) were generally comparable to, or in some studies slightly lower than, those observed following ADM-assisted or mesh-free reconstruction [7,18]. In addition, some comparative studies reported lower reconstruction failure rates with polyglactin mesh than with mesh-free techniques (e.g., 6.3% vs. 8.7%) [8,18]. These findings suggest that polyglactin mesh may provide adequate short-term implant support during the early postoperative healing period; however, they should be interpreted cautiously because of the limited number of comparative studies, heterogeneity of the available evidence, and identified risk of bias.
The range of biomaterials available for implant-based breast reconstruction continues to expand and includes multiple human-derived ADM products as well as newer injectable and flowable matrices. These materials should not be regarded as clinically interchangeable. Human-derived ADMs provide a biologic scaffold for tissue integration, whereas injectable and flowable matrices may be used primarily for soft-tissue reinforcement, contour correction, or regenerative purposes. In contrast, absorbable sheet-form synthetic meshes are intended to provide temporary structural support to the implant during early healing. Accordingly, the clinical relevance of absorbable synthetic meshes may lie in selected immediate implant-based reconstructions in which temporary stabilization and lower material costs are prioritized. Current evidence, however, is insufficient to establish their superiority over ADM or newer biomaterial technologies.
4.2. Aesthetic and Functional Outcomes
Several studies have reported favorable aesthetic outcomes and high patient satisfaction following implant-based breast reconstruction with absorbable meshes [8,9]. However, these findings should be interpreted with caution because aesthetic outcomes were assessed using different methodologies and were not consistently reported across studies.
4.3. Economic Considerations
One potential advantage of absorbable meshes is their lower material cost compared with ADM. Mookerjee et al. reported that the use of polyglactin mesh significantly reduced operative time—nearly by half (35.7 vs. 68 min with ADM)—and decreased material costs by up to 91%, corresponding to savings of approximately USD 8273 per breast [9].
Although lower rates of major complications and implant loss could theoretically reduce overall treatment costs by decreasing the need for reoperations, prolonged hospitalization, and additional surgical materials, these potential downstream savings have not been formally evaluated and should therefore be interpreted cautiously [7,10].
4.4. Comparison with Other Reconstruction Techniques
Large-scale analyses outside the studies included in this review, including the iBRA study (Potter et al.) and subsequent evaluations by DeLong et al., have reported no significant differences in early postoperative complication rates within the first three months between biosynthetic meshes, acellular dermal matrix (ADM), and mesh-free reconstruction [3,19]. Similarly, Arnautovic et al. reported comparable outcomes across different reconstructive approaches [20]. Taken together, these findings suggest that the choice of implant support material should consider not only complication rates but also patient characteristics, surgeon experience, material availability, and economic factors.
4.5. Patient Selection and Risk Factors
The study by Vohra et al. reported a higher risk of postoperative complications among patients with elevated body mass index and comorbidities such as diabetes and hypertension, emphasizing the importance of careful patient selection [8]. These findings suggest that individualized treatment planning remains important regardless of the reconstruction technique used.
4.6. Limitations
Despite promising results, the current evidence base remains limited. Most included studies were retrospective, with relatively small sample sizes and short follow-up periods, typically not exceeding 12 months. Consequently, long-term outcomes, including capsular contracture, implant malposition, and durability of aesthetic results, remain insufficiently evaluated.
Furthermore, the lack of standardized outcome measures, particularly for quality of life and patient satisfaction, limits the ability to perform direct comparisons between studies.
The comparison between absorbable meshes and ADM should be interpreted cautiously. Most available evidence originates from retrospective observational studies with heterogeneous patient populations, surgical techniques, indications for mesh use, and follow-up periods. Therefore, direct comparison between different materials is subject to considerable selection bias and confounding.
Another important limitation is the marked heterogeneity of the available clinical evidence. The included clinical studies evaluated different reconstructive materials (polyglactin mesh, polydioxanone mesh, ADM, and mesh-free reconstruction), different surgical techniques (prepectoral and subpectoral reconstruction), and different study designs, including retrospective and prospective studies. This heterogeneity limited direct comparisons between studies and precluded quantitative meta-analysis. Therefore, the findings should be interpreted as a qualitative synthesis of the currently available evidence rather than definitive comparative evidence.
The formal risk-of-bias assessment further highlighted important methodological limitations of the available evidence. Most included studies were judged to have a moderate risk of bias, primarily because of their retrospective or single-arm observational designs, limited adjustment for potential confounding, selective patient populations, small sample sizes, and relatively short follow-up. These limitations reduce the certainty of direct comparisons between reconstructive materials and should be considered when interpreting the findings of this review.
In addition, the economic evidence was limited to a small number of studies reporting primarily material costs and operative time. No formal cost-effectiveness analyses were identified; therefore, the present review cannot establish the cost-effectiveness of absorbable meshes relative to ADM or mesh-free reconstruction.
The review process itself also has limitations. Only English-language studies were included, and grey literature was not systematically searched, which may have influenced the completeness of the available evidence.
4.7. Future Directions
Future research should focus on well-designed prospective, multicenter studies with larger patient cohorts and longer follow-up periods. Standardized outcome measures, including validated quality-of-life instruments, are essential to better evaluate both clinical and patient-reported outcomes.
4.8. Summary
Overall, the findings of this review suggest that absorbable synthetic meshes—particularly polyglactin mesh—may represent a feasible option for selected implant-based breast reconstructions, with clinical outcomes generally comparable to those reported for ADM-assisted or mesh-free reconstruction. Available evidence also suggests substantially lower material costs and shorter operative times compared with ADM; however, these findings should not be interpreted as evidence of formal cost-effectiveness. Given the predominantly observational evidence, methodological heterogeneity, and identified risk of bias, further prospective comparative studies and dedicated health-economic evaluations are required before definitive conclusions can be drawn.
5. Conclusions
The available evidence suggests that polyglactin mesh may represent a feasible option for temporary implant support in selected patients undergoing immediate implant-based breast reconstruction, with potential advantages in terms of material costs and operative time. However, the evidence remains predominantly retrospective and clinically heterogeneous, and the identified risk of bias limits the certainty of these findings. Evidence regarding polydioxanone mesh is limited to a single small study and is currently insufficient to establish its comparative safety, effectiveness, or economic value.
Polyglactin mesh may offer an economic advantage, with reported reductions in material costs of up to 90% and shorter operative times compared with acellular dermal matrix (ADM). However, these findings reflect material cost savings and operative efficiency rather than formal cost-effectiveness. Potential downstream cost savings related to complications, reoperations, or hospitalization have not been formally evaluated.
The most frequently reported complications—including seroma, skin necrosis, infection, and hematoma—were generally infrequent; however, interpretation of these findings is limited by study heterogeneity and risk of bias. Patient selection remains an important factor influencing outcomes, with higher body mass index and comorbidities such as diabetes and hypertension associated with an increased risk of postoperative complications.
Several studies reported favorable aesthetic outcomes and high levels of patient satisfaction; however, the lack of standardized assessment methods and limited long-term follow-up restricts objective comparison across studies.
Future research should focus on well-designed prospective, multicenter studies with larger patient cohorts and longer follow-up periods to better evaluate long-term clinical outcomes, cost-effectiveness, and patient-reported quality of life.
Abbreviations
The following abbreviations are used in this manuscript:
| ADM | Acellular dermal matrix |
| PDO | Polydioxanone |
| RBS | Red breast syndrome |
Supplementary Materials
The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/medicina62091682/s1, PRISMA 2020 Checklist.
Author Contributions
Conceptualization, A.D. and L.P.; methodology, A.D. and L.P.; literature search, A.D.; data extraction, A.D. and L.P.; writing—original draft preparation, A.D.; writing—review and editing, A.D. and L.P. All authors have read and agreed to the published version of the manuscript.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
No new data were created or analyzed in this study. Data sharing is not applicable to this article.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding Statement
This research received no external funding.
Footnotes
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