Inlay mesh reinforcement to prevent abdominal bulging following abdominal-based breast reconstruction: a retrospective comparative cohort study

Purpose: Abdominal bulging is a common complication following transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. To reduce the risk of this complication, we adopted an inlay mesh reinforcement technique to support the muscle defect.Methods: A retrospective review was conducted of all unilateral breast reconstructions using free TRAM flaps performed at our institution between 2012 and 2023. During donor-site closure, a polypropylene mesh was placed using either the traditional onlay technique or a newly introduced inlay technique. The incidence of abdominal bulging was compared between the two methods, and additional clinical variables were analyzed to identify any associations with bulging.Results: Abdominal bulging occurred in seven patients in the onlay group, whereas no cases were observed in the inlay group. This difference was statistically significant (p=0.011). No significant differences were found in the other clinical variables evaluated.Conclusion: Inlay mesh reinforcement effectively reduced the incidence of abdominal bulging after abdominal-based breast reconstruction and may serve as a superior alternative to conventional onlay methods.