Plastic and reconstructive surgery
January 22, 2026 · via Europe PMC
Retrorectus Mesh Use in Deep Inferior Epigastric Perforator Flaps to Reduce Abdominal Morbidity.
Silverman EC, Ochoa E, Maloy SH, Zhu W, Skolnick GB, Anolik RA.
AI summary — for doctors, generated from the abstract only
Placing absorbable P4HB mesh behind the rectus during DIEP flap harvest was associated with about a third as many abdominal bulges.
What was studied
A single-surgeon retrospective review of 118 DIEP flap patients (2020-2024), 59 with retrorectus P4HB mesh and 59 without.
Key findings
- Abdominal bulge occurred in 5.1% with mesh versus 18.6% without (P = 0.04)
- Hernia rates did not differ and were low
- Seroma and infection rates were similar
Clinical relevance
Abdominal bulge is a recognized donor-site morbidity of DIEP reconstruction, and temporary mesh avoids permanent mesh risks.
Who should care
Limitations
A single-surgeon retrospective comparison where mesh use began partway through the study, so time trends and a diagnosis of bulge made clinically may bias the result.
Consider retrorectus P4HB mesh to reduce bulge in DIEP harvest, recognizing the evidence is retrospective.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Deep inferior epigastric perforator (DIEP) flaps provide a durable, autologous breast reconstruction option, but can lead to postoperative abdominal bulges and hernias. There is no current standardization in practice for fascial closure or mesh placement. Bioprosthetic poly-4-hydroxybutyrate (P4HB) mesh allows for temporary abdominal support without the long-term risks of permanent mesh.
Methods
A retrospective chart review was conducted of a single surgeon's patients who underwent DIEP flaps from 2020 through 2024. During the study period, the primary surgeon began using retrorectus bioprosthetic P4HB mesh before fascial closure. Abdominal bulge was a clinical diagnosis made by the attending surgeon, and any patient with concern for a hernia received postoperative imaging. Analysis was conducted with R and included the Fisher exact test, Shapiro-Wilk test, Mann-Whitney U test, and t tests.
Results
This study included 118 patients, 59 with mesh and 59 without mesh, with similar baseline patient demographics. There was a 5.1% bulge rate in the group with mesh compared with 18.6% in those without mesh ( P = 0.04). There was no significant difference in hernia rates, with the base rate remaining low for these patients ( P = 1.0). There were no statistically significant differences in rates of seroma or infection between the groups ( P = 1.0).
Conclusions
There was a 3-fold decrease in the rate of abdominal bulge after DIEP flap surgery with retrorectus P4HB mesh. True hernia risk remains low in these patients. Retrorectus mesh placement is a straightforward and quick addition to DIEP flap harvest and may help reduce the abdominal morbidity of this surgery.
DOI
10.1097/prs.0000000000012846
PMID
41569107
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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