Peer-reviewed veterinary case report
Mesh use in DIEP flap breast reconstruction and hernia risk
By Tobin MJ et al.·2026·Department of Surgery·View original on Europe PMC →
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Original publication title: Selective Mesh Placement in DIEP Flap Reconstruction: Insights From a Propensity Score-Matched Analysis.
Plain-English summary
This study looked at a surgical technique called DIEP flap reconstruction, which is often used for breast reconstruction after surgery. Some surgeons use a material called mesh to help prevent hernias (bulges that can occur after surgery) at the site where they took tissue from the abdomen. Researchers analyzed a large group of patients to see if using mesh actually helped reduce the risk of hernias or other problems after surgery. They found that while mesh was more likely to be used in patients who were older, had a higher body weight, or had a history of hernias, it did not significantly lower the chances of developing hernias or complications at the surgery site in the long run. Overall, the study suggests that using mesh may not be as helpful as previously thought, and doctors might need to consider other ways to prevent complications after this type of surgery.
Abstract
Deep inferior epigastric perforator (DIEP) flaps are the gold standard in autologous breast reconstruction (ABR) despite being associated with significant abdominal donor-site morbidity. Some surgeons place mesh during abdominal closure to potentially mitigate the risk of postoperative hernias. Nonetheless, existing research on the efficacy of this practice has been limited by small cohort studies. This study aims to evaluate factors that influence mesh placement in DIEP ABR and to assess the short- and long-term effects of mesh placement on postoperative hernia development and donor-site morbidity using a large healthcare database. The TriNetX health database was queried to identify patients who underwent DIEP flap reconstruction with or without abdominal mesh using CPT and HCPCS codes. Cox regression analysis was performed to identify significant covariates influencing both mesh placement and postoperative hernia risk. Patients with BMI of ≥30 kg/m2 were stratified by mesh placement and propensity-score matched 1:1 by demographics and comorbidities. Risk ratios were calculated to determine 5-year hernia rates between the matched cohorts. Among 12,593 patients who underwent DIEP ABR, 1100 patients (8.7%) had abdominal mesh placed at the time of surgery. Cox regression demonstrated that a BMI of ≥30 kg/m2 and advanced age were significant predictors of postoperative hernias (P < 0.0001). ABR patients were more likely to receive mesh if they had a BMI of ≥30 kg/m2 (P < 0.0001), prior hernia repairs (P < 0.05), tobacco use (P < 0.05), or advanced age (P < 0.01). After propensity-score matching, mesh placement did not significantly reduce 30-day donor-site morbidity or 5-year hernia rates in patients with a BMI of ≥30 kg/m2. These findings suggest that surgeons preferentially place mesh in patients they perceive to be at high risk of postoperative complications, particularly those with obesity, history of hernia repairs, tobacco use, and advanced age. Nonetheless, mesh placement during DIEP reconstruction does not provide the anticipated protective effect against postoperative hernias or reduction in donor-site morbidity, even in higher risk patients with a BMI of ≥30 kg/m2. These findings challenge the routine use of mesh during abdominal closure in DIEP flap breast reconstruction and suggest that more targeted approaches to reducing donor-site complications are warranted.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41604503