Comparison of Phasix, polypropylene, and primary closure of the abdominal donor site after bilateral free flap breast reconstruction: Long-term evaluation of abdominal hernia and bulge formation

Microsurgery. 2020 May;40(4):434-439. doi: 10.1002/micr.30541. Epub 2019 Dec 9.


Background: Abdominal free flap harvest for breast reconstruction may result in significant morbidity in terms of hernias and bulges. Reinforcement of the donor site with mesh has been recommended to minimize the risk of hernias and bulges, but no studies exist evaluating the optimal type of mesh. Polypropylene has traditionally been used but the development of Phasix restorable mesh may be a reasonable alternative. Here, we compared the use of Phasix to polypropylene and primary closure and hypothesize that the former has lower rates of abdominal morbidity in the long term.

Patients and methods: A retrospective review of all patients undergoing bilateral free flap breast reconstruction from the abdomen was performed while patients with pedicle flaps or alternative donor sites were excluded. Patient demographics, medical/surgical history, cancer treatments, and flap type were analyzed. All patients were monitored for a minimum of 2 years for early donor site complications as well as hernia/bulges.

Results: Sixty-six consecutive patients were included (40 patients with Phasix, 20 patients with polypropylene, and 6 patients with primary closure). Use of Phasix mesh resulted in higher initial operative costs ($2,750 vs. $72 vs. $0). Two patients with polypropylene mesh and one patient undergoing primary closure developed an abdominal bulge in an average follow-up of 25.2 months (11.5% vs. 0%, p = .04).

Conclusions: Mesh placement for abdominal wall reinforcement after bilateral free flap breast reconstruction minimizes the risk of hernias and bulges. Although Phasix results in increased initial costs, abdominal morbidity is significantly decreased after follow-up beyond 2 years.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Wound Closure Techniques / adverse effects*
  • Adult
  • Aged
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Female
  • Free Tissue Flaps / adverse effects*
  • Hernia, Abdominal / epidemiology*
  • Humans
  • Mammaplasty / adverse effects*
  • Middle Aged
  • Polypropylenes
  • Postoperative Complications / epidemiology*
  • Surgical Mesh
  • Sutures
  • Time Factors
  • Transplant Donor Site / surgery*


  • Polypropylenes