Early Experience with Synthetic Monofilament Polydioxanone Mesh in Primary Breast Reconstruction: A Propensity Matched Analysis

Abstract Polydioxanone (PDS) mesh is an emerging technology for prosthetic breast reconstruction. However, there is a paucity of data on its safety and efficacy in primary breast reconstruction. Demographic and outcomes measures from consecutive, immediate prosthetic breast reconstructions using PDS or acellular dermal matrix (ADM) from a single surgeon were evaluated on a per-breast basis between 2013 and 2023. Propensity matching based on demographic variables was conducted. Binary logistic regression analyses were performed to assess the impact of the mesh. A total of 796 breast reconstructions were identified, and propensity matching yielded 192 ADM and 48 PDS mesh reconstructions. There was no significant difference with respect to age, American Society of Anesthesiologists (ASA) status, smoking history, diabetes, mastectomy indication, radiation, chemotherapy, expander plane, and mastectomy type between propensity matched cohorts. Body mass index (BMI) varied by 2.1 points (ADM: 25.8 vs. PDS: 23.7, p = 0.01). Mean follow-up time was 13.5 ± 2.7 months. The propensity-matched PDS mesh cohort had lower rates of any complication (ADM: 23.9% vs. PDS mesh: 4.2%, p = 0.003), seroma (ADM: 11.4% vs. PDS mesh: 0%, p = 0.01), expander exposure (ADM: 12.5% vs. PDS mesh: 0%, p = 0.01), complication-associated expander removal (ADM: 9.9% vs. PDS mesh: 0%, p = 0.02), and mastectomy flap necrosis (ADM: 14.0% vs. PDS mesh: 4.2%, p = 0.05). PDS mesh, compared to ADM, was independently associated with decreased risk of any complication (OR: 0.443, p = 0.02), seroma (odds ratio [OR]: 0.456, p = 0.03), expander exposure (OR: 0.277, p = 0.03), complication-associated expander removal (OR: 0.211, p = 0.02), and mastectomy flap necrosis (OR: 0.12, p = 0.04). PDS mesh is an alternative to ADM in primary prosthetic breast reconstruction. Rates of complication—including infection, seroma, and explantation—suggest an acceptable safety profile relative to ADM.