Attitudes toward Biological Mesh in Breast Reconstruction: A Regional Survey of Plastic Surgeons

Abstract

Sir: The use of biological mesh in breast reconstruction has become more popular among plastic surgeons. However, the relative risks and benefits of breast reconstruction with biological mesh compared with nonmesh methods have not been well established. We designed a survey to assess the current trends and opinions of regional plastic surgeons regarding the use of biological mesh in breast reconstruction. A Web-based survey was e-mailed in February of 2009 to an address list of Florida plastic surgeon members of the American Society of Plastic Surgeons. The 370 active members with listed e-mail addresses were included. Questions relating to the use of biological mesh and their perceived complications were surveyed. There were 71 responses of 370 surveyed, for a response rate of 19 percent. A total of 52 of 71 respondents (73 percent) reported that they have used biological mesh in their breast reconstruction practice. Of this group of 71 respondents, 30 (42 percent) had used allograft only, seven (10 percent) had used xenograft only, and 16 (23 percent) reported direct experience with both types of biological mesh. Of current biological mesh users in this group, 21 (30 percent) do not see any relative increase in risk compared with nonmesh methods; 16 (23 percent) see an increase in minor complications such as seroma, cellulitis, and minor wound infection; and only six (9 percent) see an increase in major, implant-threatening complications.1,2 Despite these views, the majority of those who had experience with biological mesh feel that the perceived advantages such as establishing an inframammary and lateral mammary fold, decreasing implant visibility, and enabling one-stage immediate reconstruction outweigh the risks.3 Those with no experience with biological mesh accounted for most surgeons who believe that, conversely, the risks outweigh the advantages. The relationship between surgeon experience and surgeon opinion regarding use of biological mesh in breast reconstruction is summarized in Figure 1.Fig. 1.: Relationship between surgeon experience and surgeon opinion regarding use of biological mesh (BM) in breast reconstruction.These results provide a regional snapshot of plastic surgeon attitudes toward the use of biological mesh in breast reconstruction in Florida. A majority of surgeons with personal experience using biological mesh believe that it increases complication rates. Despite this perceived increase, the majority stated they would continue to use the biological mesh in their breast reconstructions and believe that the benefits outweigh the risks. In contrast, surgeons who have never used biological mesh have a negative view of these products. The use of biological mesh in breast reconstruction is becoming more widespread despite concerns about a perceived increased complication rate. Further studies are needed to better quantitatively assess the risks and benefits of biological mesh in breast reconstruction. DISCLOSURE Martin I. Newman, M.D., serves as a consultant to several biological mesh providers, including LifeCell, Ethicon, and Synovis. Michel C. Samson, M.D., serves as a consultant to several biological mesh providers, including Johnson & Johnson and Synovis. Neither of the other authors has anything to disclose. Kristen M. Rezak, M.D. Kelley Gillette, B.S. Michel C. Samson, M.D. Martin I. Newman, M.D. Department of Plastic Surgery Cleveland Clinic Florida Weston, Fla.