Does the addition of mesh improve outcomes in implant based breast reconstruction after mastectomy for breast cancer?

### What you need to know Of the 55 000 women diagnosed with breast cancer1 each year in the UK, more than 40% require a mastectomy2 as primary surgical treatment. To optimise quality of life and outcomes, the National Institute for Health and Care Excellence (NICE) recommends offering immediate breast reconstruction.3 In the UK4 and US,5 implant based breast reconstruction (IBBR) is the most commonly performed technique. The implant is usually placed in a pocket under the pectoralis major muscle. This generally requires a two-stage approach as the pocket is not large enough to accommodate a fixed volume implant. A tissue expander is placed as a first stage and it is expanded by injecting fluid percutaneously until the desired size is achieved. The expander is then replaced by a fixed volume implant at a second operation. This technique is safe,6 but time consuming and uncomfortable. It is possible to use combined expander implants (“permanent expanders”) as a one-stage approach to avoid a second operation, but the results may be unsatisfactory.7 The introduction of biological and synthetic meshes in the early 2000s to augment the submuscular pocket has had a major impact on the practice of IBBR. The mesh can be used as a sling between the lower …