Subcutaneous Tissue Expander Placement with Synthetic Titanium-Coated Mesh in Breast Reconstruction: Long-term Results

In the United States, 2-stage implant-based breast reconstruction (IBBR) accounts for approximately 70% of reconstructions after mastectomy,1 and majority of reconstructions are performed by means of acellular dermal matrices (ADMs).2 Biological matrixes are the most used worldwide,3 although synthetic meshes are widespread too, as titanium-coated polypropylene mesh (TiLOOOP Bra, pfm medical, Cologne, Germany) in Europe.4 Such devices, either ADMs or meshes, are traditionally adopted as a muscle extension, creating a “dual plane” coverage of tissue expander (TE)/implant, as described by Spear et al.5 In 2014, a different approach with subcutaneous implant placement by means of a full synthetic mesh or ADMs coverage was described in direct-to-implant reconstructions.6–8 Moreover, a recent article shows a significant difference in capsular thickness between TEs placed subcutaneously and those placed in standard submuscular position.9 Aim of this report is to analyze surgical safety and long-term outcomes of subcutaneous TE 2-stage reconstruction using a synthetic mesh.