Figure 5: Deformed mesh results in vaginal thinning consistent with stress shielding.

Lateral view of a Predeformed mesh-vagina complex demonstrating dramatic vaginal thinning over an area of deformed mesh (left). Representative Masson’s trichrome images of A) Sham, B) Stable, C) Unstable, and D) Predeformed configurations, demonstrating progressively increased crowding of mesh fibers with pore collapse in the Unstable configuration and pore collapse and wrinkling in the Predeformed group. Also apparent is marked thinning of the vagina, especially the smooth muscle layer (*), particularly in the Predeformed group, in which a high mesh burden, minimal tissue incorporation, and excessive matrix deposition (evidenced by faint pink staining within the adventitia layer) between the mesh pores (arrow) was observed (D).