Surgical and Patient-Reported Outcomes After Mastectomy and Implant-Based Prepectoral Reconstruction Using TIGR® Synthetic Mesh

Abstract

Background Single-stage direct-to-implant (DTI) breast reconstruction after mastectomy has gained popularity over the last decade, thanks to the wide use of biological matrices and synthetic meshes. Despite their high cost, there is no evidence of superior outcome from the biological matrices compared to the synthetic meshes. In this study, we aimed to evaluate our experience with TIGR, a synthetic, long-term absorbable mesh, in mastectomy and immediate breast reconstruction (MIBR) with a focus on patient-reported outcomes (PROMs). Methods This was a single-trust prospective quality improvement study conducted between 2017 and 2019. The main objectives were complication rates including infection, implant loss, and other surgical complications in patients undergoing TIGR mesh-assisted MIBR in the prepectoral plane for either cancer or risk reduction. PROMs were measured using the validated European Organisation for Research and Treatment of Cancer (EORTC) breast questionnaire module. Clinical evaluations were conducted at one week, three weeks, and 12 months postoperatively. All patients provided written consent, and the audit was registered with the Quality Improvement Department of the organization. Results One hundred and twelve meshes were used in 93 patients with a mean age of 49 (24-75) years and a body mass index (BMI) of 23.4 (19.1-29.6). During the follow-up period, complications occurred in 26 patients (28%), including infection in four (4.3%), complete skin flap necrosis in one (1%), partial flap necrosis in three (3.2%), and implant loss in four (4.3%) patients. PROM data from 41 individuals indicated a moderate overall quality of life (82.7%), with high functional domain scores with relatively lower emotional functioning scores. Symptom domains generally scored poorly except for body image and sexual functioning. Conclusion Mastectomy and immediate prepectoral breast reconstruction using TIGR mesh is safe with low major complication rates. It is associated with high functional and quality of life scores but low scores in symptom domains which could be multifactorial. However, limitations due to study type and follow-up duration suggest caution in generalizing findings.

Keywords: acellular dermal matrix; breast cancer; breast reconstruction; mibr; prepectoral reconstruction; quality of life; synthetic mesh; tigr matrix.

Figure 1. Graphic representation of quality of life scores

Figure 2. (A) Preoperative photos of a patient with right breast cancer after NACT. (B) Postoperative photo after right skin-reducing and nipple-sparing mastectomy using implant/expander hybrid device and TIGR mesh

NACT: neoadjuvant chemotherapy

Figure 3. (A) Preoperative photos of a patient with left breast cancer. (B) Postoperative photo after left nipple-sparing mastectomy with direct-to-implant-based reconstruction using TIGR mesh

Figure 4. (A) Postoperative patient with right skin-reducing mastectomy and implant-based reconstruction using TIGR mesh. (B) Same patient with partial skin necrosis at the suture line managed conservatively