Comparison of Complication Rates Between P4HB and PDO Meshes in Direct-to-Implant Primary Breast Reconstruction

GOALS/PURPOSE: The use of mesh in breast reconstruction is well described to provide soft tissue support and mitigate the risk capsular contracture. Several studies have established the benefits of newer synthetic meshes over acellular dermal matrices (ADMs); however limited studies have assessed outcomes between mesh products. The goal of this study was to compare postoperative complications when using poly-4-hydroxybutyrate (P4HB) versus polydioxanone (PDO) mesh. METHODS: A single-institution retrospective review was performed to assess direct-to-implant primary reconstructions between 2023 and 2025 using either P4HB or PDO at the time of reconstruction. Demographics were compared between the two cohorts. Postoperative complications including flap necrosis, infection, dehiscence, hematoma, seroma, and implant loss were assessed. Univariate and multivariate regressions were performed to determine independent predictors of major, minor, or overall complications. Data was analyzed using SAS (Cary, NC). Statistical significance was set to p<0.05. RESULTS: 382 breasts were included in this study, 88 reconstructed with PDO and 294 with P4HB. 15.9% of PDO breasts experienced a complication, compared to 21.4% of P4HB breasts (p=0.29). PDO breasts experienced significantly higher implant loss (5.7% versus 2.4%, p=0.03), but there was no significant difference in any other recorded complication. Multivariate regression demonstrated no significant difference in overall complications between PDO and P4HB (OR 0.6, 95% CI 0.3-1.1, p=0.11). CONCLUSION: Absorbable synthetic mesh provides a safe, cost-effective option in breast reconstruction patients with no significant difference in short-term complications between PDO and P4HB meshes.