Short-term Outcomes of PDO Synthetic Mesh in Two-stage Breast Reconstruction: A Single Center Comparative Study

Background Polydioxanone (PDO) mesh offers a more cost-effective option for soft-tissue support for two-stage breast reconstruction with tissue expansion compared to biologic mesh, but differences in complication rates have not been well established. Objectives The purpose of this study was to present a single centers’ early postoperative complications following immediate tissue expander (TE) insertion for breast reconstruction using PDO mesh, biologic mesh, or no mesh. Methods This is a retrospective cohort study of patients undergoing immediate TE insertion following mastectomy between July 2021 to 2024 at a single academic center. Patients were grouped by mesh type. Univariate and multivariate regression analyses were performed. Results A total of 919 TEs in 524 patients were analyzed, with 27.7% with PDO mesh, 52.9% with biologic mesh, and 19.5% with no mesh. TE infection occurred in 70 breasts (7.6%) in 55 patients (10.5%), with infection rates of 10.6% in the PDO mesh group, 6.6% in the biologic mesh group, and 6.2% in the no mesh group (p=NS). Ipsilateral radiation exposure was the only factor significantly associated with infection (OR 7.2, p=0.008). Among prepectoral reconstructions, infection rates were higher compared to subpectoral cases, but mesh type was not independently associated with infection. Explantation occurred in 120 breasts (13.0%) with no difference between mesh types. Conclusions Short-term outcomes following TE placement were comparable among patients receiving PDO mesh, biologic mesh, or no mesh. These findings suggest that mastectomy flap quality and patient factors may have a greater impact on complications than mesh type, especially with prepectoral placement.