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Prophylactic Retrorectus Mesh Significantly Reduces Donor-Site Bulge in Abdominally Based Autologous Breast Reconstruction (ABABR): Analysis of 1,507 Donor Sites
Aamirah Mccutchen
*, Ayaka N. Deguchi, Timothy C. Olsen, Margaret M. Hornick, Robyn B. Broach, Joseph Serletti, Said Azoury
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Background Autologous breast reconstruction (ABR) has experienced a resurgence, as patients seek natural, long-lasting reconstructive outcomes following mastectomy. However, abdominal donor-site bulge represents a significant source of patient dissatisfaction and reoperation following abdominally based ABR (ABABR). While prophylactic mesh reinforcement has been proposed to reduce bulge formation, optimal patient selection and comparative effectiveness data remain limited. This study evaluates the impact of retrorectus prophylactic mesh placement on donor-site morbidity in one of the largest single-institution ABR cohorts reported to date.
Methods A retrospective analysis of patients undergoing ABABR from January 2014 to December 2024 was performed. Abdominal closure techniques were stratified into primary closure versus retrorectus mesh reinforcement. Primary outcomes included bulge, seroma, hematoma, surgical site infection (SSI), and delayed healing. Regression models adjusted for age, BMI, smoking status, diabetes, and flap type. Stratified analyses by obesity class were performed separately.
Results A total of 936 patients (1,507 donor sites) were analyzed. Mean age was 53 years (SD 10) and mean BMI was 29.8 kg/m2 (SD 5.8). Primary closure was performed in 520 donor sites and retrorectus mesh reinforcement in 987 donor sites. The retrorectus mesh group demonstrated significantly lower bulge rates compared to primary closure (1.0% vs. 2.9%, p=0.013). No significant differences were observed between groups for seroma, hematoma, SSI, or delayed healing (p>0.05). Multivariate regression revealed decreased bulge rates in obese patients (OR 0.11, p=0.016).
Conclusion This study demonstrates that retrorectus prophylactic mesh reinforcement significantly reduces donor-site bulge rates following ABABR without increasing wound complications. A protective effect was noted in obese patients. These data provide evidence-based guidance for surgical decision-making and inform the development of risk-stratified protocols for abdominal wall closure in ABR.
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