Hallberg, H., Lewin, R., Elander, A., Hansson, E. (2018).
J Plast Surg Hand Surg. 52(4):253.
In recent years, it has become increasingly popular to use matrices, such as acellular dermal matrices, in
implant-based breast reconstruction. This study emphasizes on the use of TIGR Mesh in a large series of immediate breast reconstruction.
The main aim of the study was to examine short-term complications following breast reconstruction with TIGR Matrix in combination with a tissue expander or an implant. The second aim was to examine predictors for complications.
All consecutive patients operated on with breast reconstruction with TIGR Matrix Surgical Mesh and tissue expanders (TEs) or permanent implant between March 2015 and September 2016 were prospectively included. Exclusion criteria were, ongoing smoking, BMI (kg/m2)>30, and planned postoperative radiation.
During the study period, 65 immediate breast reconstructions with TIGR mesh were performed in 49 patients, 16 bilateral and 33 unilateral. Fifteen breasts (23%) were affected by complications within 30 days: four (6.2%) major complications and eleven (17%) minor complications. The major complications included two implant losses and one pulmonary embolism (PE) and one reoperation due to hematoma in the same patient. The implant losses were due to wound dehiscence with exposure of the TE in one case and infection in the other case. The PE occurred despite prophylactic anticoagulation in a patient with an aortic valve replacement and an atrial fibrillation. The most common minor complication was epidermolysis not requiring revision, which occurred in three cases (4.6%). During the operation the TIGR meshes were visually well integrated. Minimum follow-up time was 17 months.
Late complications included one case of wound dehiscence treated conservatively, one case of partial areola necrosis treated conservatively, and two cases of capsular contraction, Baker grade II, not requiring correction. There were no implant losses. In addition, minor aesthetic corrections, such as dog-ear resection and lipofilling because of wrinkles, were performed in 10 breasts.
In conclusion, breast reconstruction with a tissue expander and TIGRVR Matrix Surgical Mesh can be performed with a low complication rate. The majority of the problems encountered after 30 days were minor aesthetic shortcomings. Further studies are needed to investigate the long-term complication rate, capsule formation and aesthetic result.