Efficacy of Mesh Use in Breast Surgery: A Comprehensive Review of Complications and Aesthetic Outcomes.

[BACKGROUND] The insertion of a mesh "internal bra" has been used in cosmetic breast procedures for soft-tissue reinforcement as a means to mitigate postoperative ptosis. However, there have been concerns regarding complications as a result of mesh placement and a lack of quantitative data regarding postoperative cosmetic outcomes.

[METHODS] Articles that assessed the effects of the mesh internal bra for soft-tissue support on cosmetic and patient-reported outcomes, complications, and surveillance were reviewed. Meta-analysis was performed to determine the overall complication rates, and cosmetic outcomes and patient-reported outcomes were reviewed.

[RESULTS] Meta-analysis showed the following summary effect sizes: infection/abscess had a pooled rate of 3.61% ( = 33.8,  = 76.33%), hematoma was 1.34% ( = 4.16,  = 68.1%), seroma was 5.04% ( = 14.8,  = 73.11%), fat necrosis was 0.86% ( = 693,  = 99.7%), and capsular contracture was 2.5% ( = 693.4,  = 99.6%). Only 2 of 5 studies attempting to quantify cosmetic outcomes compared outcomes between patients who underwent procedures with and without the use of mesh. Both reported smaller increases in sternal notch-to-nipple distance and nipple-to-inframammary fold distance without clear statistical significance.

[CONCLUSIONS] Although there does not seem to be a significant difference in risk profile with and without the use of mesh, the current data do not support the claims of improved cosmetic outcomes. Well-controlled, quantitative studies are necessary to objectively evaluate the cosmetic benefits of using mesh.