HERNIA PREVENTION AND AESTHETIC CONTOURING OF THE ABDOMEN FOLLOWING TRAM FLAP BREAST RECONSTRUCTION BY THE USE OF POLYPROPYLENE MESH

The value of synthetic mesh use in the treatment of recurrent abdomina l hernias is well recognized and has led to its advocacy by some autho rs as an adjunct in primary hernia repair. Mesh use in the donor-site closure associated with TRAM flap reconstruction is typically restrict ed to situations where undue tension or questionable tissue integrity may be predisposing factors to herniation. Although more liberal use o f mesh has been advocated for these circumstances, fear of mesh compli cations may continue to restrict its use. We present a series of 65 co nsecutive patients who had routine mesh application to fascial closure s following TRAM flap breast reconstruction. The use of mesh provides an added margin of strength to fascial reconstruction and was found to have additional benefit as a technical adjunct to the aesthetic aspec ts of the abdominoplasty. Mean patient follow-up was 56.4 months. The resulting rates of hernia (1.5 percent) and mesh-related infection (1. 5 percent) demonstrate its considerable safety. We recommend considera tion of polypropylene mesh use for improved strength and aesthetic qua lity of the donor-site closure following TRAM flap breast reconstructi on.