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Short-term Outcomes of Polydioxanone Synthetic Mesh in 2-stage Breast Reconstruction: A Single-Center Comparative Study

Year: 2026

Type: article

Abstract: BACKGROUND: Polydioxanone (PDO) mesh offers a more cost-effective option than biologic mesh for soft tissue support for 2-stage breast reconstruction with tissue expansion but differences in complication rates have not been well established. OBJECTIVES: The purpose of this study was to present the early postoperative complications recorded by a single center following immediate tissue expander (TE) insertion for breast reconstruction using PDO mesh, biologic mesh, or no mesh. METHODS: A retrospective cohort study was performed of patients undergoing immediate TE insertion following mastectomy over a 3-year period (2021-2024) at a single academic center. Patients were grouped by mesh type. Univariate and multivariate regression analyses were performed. RESULTS: A total of 919 TEs in 524 patients were analyzed: 27.7% with PDO mesh, 52.9% with biologic mesh, and 19.5% with no mesh. TE infection occurred in 70 breasts (7.6%) in 55 patients (10.5%), with infection rates of 10.6% in the PDO mesh group, 6.6% in the biologic mesh group, and 6.2% in the no mesh group (P = NS). Ipsilateral radiation exposure was the only factor significantly associated with infection (odds ratio, 7.2; P = .008). Prepectoral reconstructions resulted in higher infection rates than subpectoral cases, but mesh type was not independently associated with infection. Explantation occurred in 120 breasts (13.0%) with no difference between mesh types. CONCLUSIONS: Short-term outcomes following TE placement were comparable among patients receiving PDO mesh, biologic mesh, or no mesh. These findings suggest that mastectomy flap quality and patient factors may have a greater impact on complications than mesh type, especially with prepectoral placement. LEVEL OF EVIDENCE: 3 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.

Source: Aesthetic Surgery Journal

DOI: 10.1093/asj/sjag019