THE USE OF MESHES IN BREAST RECONSTRUCTION

Advances in oncoplastic breast surgery and modern systemic therapies have significantly increased breast-conserving surgery rates; however, mastectomy remains necessary for up to 40% of patients. Implant-based breast reconstruction (IBBR) continues to be the most common reconstructive approach worldwide, with the integration of biologic and synthetic meshes revolutionizing outcomes. Mesh-es provide additional soft tissue support, improved aesthetic results, and enable techniques such as direct-to-implant and prepectoral reconstruction. Biological meshes, derived from human or animal tissues, promote neovascularisation but are associated with higher costs and complication rates, in-cluding seroma and infection. Synthetic meshes, constructed from absorbable or non-absorbable poly-mers, offer comparable or superior results, with lower complication rates and greater affordability. Dual-plane (subpectoral) and prepectoral techniques are the two primary mesh-assisted approaches, the latter increasingly favored for reduced pain and absence of animation deformity. While postmas-tectomy radiotherapy remains challenging, evidence suggests mesh use may mitigate capsular con-tracture. Emerging technologies such as 3D-printed and drug-loaded meshes offer future potential for personalized, regenerative reconstruction. The choice between biologic and synthetic meshes—or even a no-mesh approach—should be individualized based on patient anatomy, oncologic safety, and resource availability. Ultimately, meticulous mastectomy technique remains the cornerstone of suc-cessful reconstructive outcomes.