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To evaluate outcomes of biological versus synthetic mesh in immediate implant based breast reconstruction, focusing on implant loss, return to theatre, infection, and seroma, using both comparative and non-comparative studies.

PRISMA-guided systematic review and meta-analysis (PROSPERO: CRD42025642325). MEDLINE and EMBASE (via Ovid) were searched to 27 June 2024 for onestage implant reconstructions using biological or synthetic mesh. Outcomes were pooled for single-arm studies (random-effects, Freeman–Tukey transformation) and odds ratios were synthesized for comparative studies (random- effects DerSimonian–Laird). Heterogeneity and small-study effects were assessed using standard metrics.

Fifty studies met criteria: 39 non-comparative and 11 comparative. In non-comparative studies, pooled complication rates were: infection 5% (biologic) vs 4% (synthetic); seroma 6% vs 6%; implant loss 7% vs 4%; return to theatre 13% vs 10%; with substantial heterogeneity. Across biological mesh subtypes, comparative studies showed broadly similar performance for all four outcomes. Two head-to-head studies of biological versus synthetic meshes found no significant differences.

Current evidence suggests biological and synthetic meshes have comparable rates of infection, seroma, implant loss, and return to theatre in immediate direct-to-implant reconstruction. Forthcoming randomized studies, such as our BioSym trial will further define their optimal use.

The aim of this study was to describe our experience with implant-based breast reconstruction using Exashape™, a bilayer acellular dermal matrix (ADM) derived from bovine pericardium. Exashape™ is available in a pre-shaped form for prepectoral reconstruction and a half-moon or rectangular shape for submuscular reconstruction.

In May 2024, we began using the Exashape™ ADM. Thirty-three patients with breast cancer were enrolled and underwent unilateral (16) or bilateral (17) skin- or nipple-sparing mastectomy, for a total of 50 breast reconstructions. All implants were assembled with Exashape™ and positioned either in the prepectoral plane (40) or subpectoral plane (10). We evaluated complication rates, including seroma, infection, red breast syndrome, and re-operation. We also assessed implant rotation, as anatomical microtextured implants were used, which are generally less stable than macrotextured implants.

Among the 33 patients, 11 underwent direct-to-implant reconstruction, 15 underwent staged reconstruction with initial tissue expander placement, and 7 underwent implant exchange due to capsular contracture . The majority of reconstructions were performed in the prepectoral plane. Subpectoral reconstruction was primarily performed in patients undergoing implant exchange in whom the existing subpectoral pocket was maintained.
Among the 50 reconstructed breasts, 7 complications were observed, including 4 seromas and 3 infections. No cases of red breast syndrome were observed, and no re-operations were required. One case of capsular contracture occurred one year postoperatively following radiotherapy. No implant rotations were observed.

Exashape™ proved to be a useful adjunct in implant-based breast reconstruction, providing good aesthetic and functional outcomes. It appears to reduce the risk of implant rotation when using anatomical microtextured implants.

Implant-based breast reconstruction (IBBR) using synthetic or biological mesh is widely performed after mastectomy. However, comparative evidence on postoperative complications between different mesh types remains limited and inconsistent in the current literature. As radiotherapy (RT) and chemotherapy (CT) are common in breast cancer treatment and may affect reconstructive outcomes, their potential confounding effects need to be considered. The aim of this study was to evaluate complications associated with synthetic and biological mesh and to perform a risk analysis of RT and CT.

We conducted a retrospective single-center cohort study including patients who underwent IBBR with mesh at a Swiss hospital between 2018 and 2024. We analyzed the use of synthetic vs. biological mesh. The primary endpoint was the occurrence of implant-related complications, defined as capsular fibrosis, implant infection, implant failure, seroma, or hematoma. Time-to-event outcomes were analyzed using Kaplan–Meier and Cox proportional hazards models. RT and CT were included as covariates.

91 patients underwent IBBR with biological (n = 47) or synthetic mesh (n = 43). Complications occurred predominantly within the first postoperative year. Use of synthetic mesh was associated with higher complication rates during the first two postoperative years. In this group significant differences were observed for capsular fibrosis and seroma formation. Other complications were similar in both groups. RT was significantly and independently associated with higher overall complication rates. Whereas no evidence was found for an association between CT and postoperative outcomes.

IBBR using synthetic and biological mesh is associated with different postoperative complication profiles, especially during the first two postoperative years. Radiotherapy as an independent risk factor was confirmed. These findings highlight the importance of outcome analyses to support patient counselling and to guide decision-making regarding reconstructive strategy, particularly in patients undergoing oncologic treatment.