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Beyond Biologics

Absorbable Mesh as a Low-Cost, Low-Complication Sling for Implant-Based Breast Reconstruction

Loustau, Hugo D. M.D.; Mayer, Horacio F. M.D.

Author Information
Plastic and Reconstructive Surgery: August 2014 - Volume 134 - Issue 2 - p 323e-324e
doi: 10.1097/PRS.0000000000000334
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Sir:

It was with great interest that we read the recent article entitled “Beyond Biologics: Absorbable Mesh as a Low-Cost, Low-Complication Sling for Implant-Based Breast Reconstruction” by Tessler et al.1 The authors present a retrospective review of 50 patients who underwent implant-based breast reconstruction with an absorbable mesh as an inexpensive alternative to acellular dermal matrices and state that “the authors report the first experience in the literature using an absorbable mesh as an inferolateral sling.” However, we would like to point out that this study itself has only a confirmatory character.

The use of an absorbable mesh in direct-to-implant breast reconstruction was already reported for the very first time by us in 2007 in a multiindexed English journal, the Journal of Plastic Reconstructive and Aesthetic Surgery.2 For indexing purposes, the article included prosthetic, breast, reconstruction, and mesh as keywords.

The omission of our previous work and corresponding credit denotes an inattentive database search during the preparation and review of the article by both authors and reviewers, which should be mandatory before claiming the novelty of a study. Notwithstanding, our work indeed has been previously recognized and cited in your Journal by plastic surgeons such as Salzberg et al.3 and Saint Cyr et al.4 Furthermore, there are some technical details we would also like to stress. Although Tessler et al. propose to use the mesh as one inferolateral sling, we advocate the use of two slings, one inferior for support and one lateral for lateral contention, following the principles of our technique called the “ensured subpectoral pocket,” which seems to be more effective in splinting the pectoralis muscle and avoiding implant displacement, which is especially important when dealing with anatomical implants (Fig. 1).2

Fig. 1
Fig. 1:
Placement of the absorbable mesh in direct-to-implant breast reconstruction. Schematic representation of the ensured subpectoral pocket technique using an anatomical implant and absorbable mesh as two slings (one inferior and one lateral) as originally published in 2007. [Reprinted with permission from Loustau HD, Mayer HF, Sarrabayrouse M. Immediate prosthetic breast reconstruction: The ensured subpectoral pocket (ESP). J Plast Reconstr Aesthet Surg. 2007;60:1233–1238.]

In our article, we also address the problem related to costs of acellular dermal matrix and its availability and recommend an absorbable mesh as a readily available and inexpensive option. With similar purposes, we also recently reported the use of capsular grafts and flaps in immediate prosthetic breast reconstruction in women who have previously undergone augmentation as other alternatives to expensive acellular dermal matrices.5

Finally, we are glad to know that another group had a good experience with a low complication rate, confirming our previous results. Our experience continued to be excellent, which encouraged us to extend the use of absorbable mesh in two-stage immediate prosthetic breast reconstruction for selected cases. A more detailed description of this approach with many advantages and promising results is forthcoming.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this communication.

Hugo D. Loustau, M.D.

Horacio F. Mayer, M.D.

Department of Plastic Surgery

Hospital Italiano de Buenos Aires

University of Buenos Aires School of Medicine

Buenos Aires, Argentina

REFERENCES

1. Tessler O, Reish RG, Maman DY, Smith BL, Austen WG Jr. Beyond biologics: Absorbable mesh as a low-cost, low-complication sling for implant-based breast reconstruction. Plast Reconstr Surg. 2014;133:90e–99e
2. Loustau HD, Mayer HF, Sarrabayrouse M. Immediate prosthetic breast reconstruction: The ensured subpectoral pocket (ESP). J Plast Reconstr Aesthet Surg. 2007;60:1233–1238
3. Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. 2011;127:514–524
4. Saint-Cyr M, Dauwe P, Wong C, Thakar H, Nagarkar P, Rohrich RJ. Use of the serratus anterior fascia flap for expander coverage in breast reconstruction. Plast Reconstr Surg. 2010;125:1057–1064
5. Mayer HF, Loustau HD. Capsular grafts and flaps in immediate prosthetic breast reconstruction. Aesthetic Plast Surg. 2014;38:129–138

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