{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:09:36Z","timestamp":1779253776738,"version":"3.51.4"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Prepectoral breast reconstruction (PBR) offers several advantages, including reduced postoperative pain, fewer animation deformities, shorter operative time, better aesthetic outcomes, and greater patient comfort, and has gradually become an important option for post-mastectomy reconstruction. However, most current prepectoral reconstruction procedures still rely on mesh (such as acellular dermal matrix [ADM] or synthetic mesh) to enhance soft tissue coverage and reduce the risk of implant-related complications, such as capsular contracture and implant exposure. The use of mesh, however, also introduces additional concerns, including high cost, risk of infection, and foreign body reactions. Therefore, this study aims to compare two surgical approaches\u2014prepectoral breast reconstruction with mesh (PBR with mesh) and prepectoral breast reconstruction without mesh (PBR without mesh)\u2014in breast cancer patients, evaluating their clinical outcomes and aesthetic results, and to summarize the advantages of mesh-free prepectoral breast reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study retrospectively analyzed the clinical data of 246 patients who underwent PBR between June 2023 and December 2024. Patients were divided into two groups according to the surgical approach: the mesh-free group (128 cases, including 26 who received postoperative radiotherapy) and the mesh group (118 cases, including 25 who received postoperative radiotherapy). Baseline characteristics, perioperative indicators (such as operative time and blood loss), and postoperative complications (including infection, capsular contracture, and implant loss) were thoroughly evaluated and subjected to cost analysis. A subgroup analysis was performed specifically for the 51 patients who received postoperative radiotherapy (26 in the mesh-free group and 25 in the mesh group), with particular focus on comparing the incidence of capsular contracture between the two groups. In addition, the BREAST-Q questionnaire was used to systematically assess patients\u2019 postoperative quality of life and satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Regarding major complications, no statistically significant differences were observed between the mesh-free and mesh groups: infection rate (3.13% vs. 5.08%, p=0.527), severe capsular contracture rate (2.34% vs. 4.24%, p=0.486), wound dehiscence (2.34% vs. 3.39%, p=0.713), and implant loss rate (2.34% vs. 3.39%, p=0.713) (all p&amp;gt;0.05). Regarding perioperative indicators, there was no statistically significant difference in intraoperative blood loss and postoperative drainage volume between the two groups. The operation time in the non-patch group was significantly shorter than that in the patch group (107.50 [95.00, 120.00] vs. 125.00 [115.00, 135.00] minutes, p&amp;lt;0.001) and lower hospitalization costs (42,242.36 [39,999.14, 44,628.14] RMB vs. 60,083.01 [57,592.06, 63,443.36] RMB, p&amp;lt;0.001). In the subgroup analysis of 51 patients who received postoperative radiotherapy, the incidence of severe capsular contracture was higher in the mesh group compared with the mesh-free group (20% vs. 7.7%), although the difference did not reach statistical significance (p=0.193). BREAST-Q results showed no significant differences between the two groups in Satisfaction with breasts (54.00 [53.00, 56.00] vs. 53.50 [52.00, 55.00], p=0.051), Psychological well-being (39.50 [38.00, 41.00] vs. 39.00 [37.00, 40.00], p=0.092), or Sexual well-being (19.00 [18.00, 20.00] vs. 19.00 [18.00, 19.25], p=0.179). However, the mesh-free group had significantly higher scores in Physical well-being: chest (31 [29, 32] vs. 27 [25, 33.25], p=0.005).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In selected patient populations, mesh-free prepectoral breast reconstruction is a safe and cost-effective option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1816651","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:37:35Z","timestamp":1779251855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mesh-free prepectoral breast reconstruction: a safe and effective alternative"],"prefix":"10.3389","volume":"16","author":[{"given":"Jun","family":"Zhang","sequence":"first","affiliation":[{"name":"Thyroid and Breast Medical Center, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai-Kuo","family":"Yu","sequence":"additional","affiliation":[{"name":"Thyroid and Breast Medical Center, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zi-Fan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"An","sequence":"additional","affiliation":[{"name":"Department of Breast Disease, Weifang Maternal and Child Health Hospital","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-Hao","family":"Yu","sequence":"additional","affiliation":[{"name":"The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Thyroid and Breast Medical Center, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-5691.21.08987-5","article-title":"Current trends in breast reconstruction","volume":"76","author":"Salgarello","year":"2021","journal-title":"Minerva Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.21037\/atm-23-1724","article-title":"Tissue engineering strategies for breast reconstruction: a literature review of current advances and future directions","volume":"12","author":"Berkane","year":"2024","journal-title":"Ann Transl Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/PRS.0b013e3182729cde","article-title":"A paradigm shift in U.S. breast reconstruction: increasing implant rates","volume":"131","author":"Albornoz","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-197106000-00008","article-title":"Reconstruction of the female breast following radical mastectomy","volume":"47","author":"Snyderman","year":"1971","journal-title":"Plast Reconstr Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/00006534-198202000-00001","article-title":"Breast reconstruction after mastectomy using the temporary expander","volume":"69","author":"Radovan","year":"1982","journal-title":"Plast Reconstr Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010070","article-title":"No differences in surgical and patient-reported outcomes among AlloDerm, SurgiMend, and Dermacell for prepectoral implant-based breast reconstruction","volume":"151","author":"Asaad","year":"2023","journal-title":"Plast Reconstr Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-023-03500-1","article-title":"Implant based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP\u00ae Bra): a systematic review and meta-analysis","volume":"48","author":"Zhang","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7507\/1002-1892.202210100","article-title":"Renaissance of prepectoral implant-based breast reconstruction: theoretical basis and research status","volume":"37","author":"Lin","year":"2023","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2019.05.015","article-title":"Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: a systematic review and meta analysis","volume":"45","author":"Li","year":"2019","journal-title":"Eur J Surg Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-022-12567-0","article-title":"Prepectoral versus subpectoral implant-based breast reconstruction: a systemic review and meta-analysis","volume":"30","author":"Ostapenko","year":"2023","journal-title":"Ann Surg Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zraa063","article-title":"Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh","volume":"5","author":"Sewart","year":"2021","journal-title":"BJS Open"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004047","article-title":"Prepectoral implant-based breast reconstruction: rationale, indications, and preliminary results","volume":"139","author":"Sigalove","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010712","article-title":"Early complications in prepectoral breast reconstructions with and without acellular dermal matrix: a preliminary analysis of outcomes","volume":"153","author":"Plotsker","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000000549","article-title":"Subcutaneous tissue expander placement with synthetic titanium-coated mesh in breast reconstruction: long-term results","volume":"3","author":"Casella","year":"2016","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004048","article-title":"Prepectoral immediate direct-to-implant breast reconstruction with anterior AlloDerm coverage","volume":"140","author":"Jones","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/PRS.0000000000002243","article-title":"Two-stage implant-based breast reconstruction: an evolution of the conceptual and technical approach over a two-decade period","volume":"138","author":"Cordeiro","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000004047","article-title":"Two-stage prosthetic breast reconstruction: a comparison between prepectoral and partial subpectoral techniques","volume":"147","author":"Nahabedian","year":"2021","journal-title":"Plast Reconstr Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"43S","DOI":"10.1097\/PRS.0000000000010380","article-title":"Surgical and patient-reported outcomes of 694 two-stage prepectoral versus subpectoral breast reconstructions","volume":"152","author":"Asaad","year":"2023","journal-title":"Plast Reconstr Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007787","article-title":"Evaluation of prepectoral implant placement and complete coverage with TiLoop Bra mesh for breast reconstruction: a prospective study on long-term and patient-reported outcomes","volume":"147","author":"Casella","year":"2021","journal-title":"Plast Reconstr Surg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17060925","article-title":"Oncological safety of prepectoral implant-based breast reconstruction after conservative mastectomy: insights from 842 consecutive breast cancer patients","volume":"17","author":"Scardina","year":"2025","journal-title":"Cancers (Basel)"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318200a961","article-title":"An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm)","volume":"127","author":"Salzberg","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"8e","DOI":"10.1097\/PRS.0b013e318290f8a0","article-title":"Implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra): a multicenter study of 231 cases","volume":"132","author":"Dieterich","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1350930","article-title":"Biological matrices and synthetic meshes used in implant-based breast reconstruction - a review of products available in Germany","volume":"73","author":"Dieterich","year":"2013","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"B25","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.bjps.2024.07.060","article-title":"Breast reconstruction with TiLOOP\u00ae Bra: another arrow in plastic surgeons' quiver","volume":"97","author":"Tellarini","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s00266-022-03026-y","article-title":"The impact of postmastectomy radiation therapy on the outcomes of prepectoral implant-based breast reconstruction: a systematic review and meta-analysis","volume":"47","author":"Awadeen","year":"2023","journal-title":"Aesthetic Plast Surg"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.04.030","article-title":"Prepectoral breast reconstruction is safe in the setting of post-mastectomy radiation therapy","volume":"75","author":"Long","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-023-03661-z","article-title":"The impact of adjuvant radiotherapy on immediate prepectoral implant-based breast reconstruction","volume":"48","author":"Ostapenko","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/PRS.0b013e3181aee987","article-title":"Radiation therapy and breast reconstruction: a critical review of the literature","volume":"124","author":"Kronowitz","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s10549-011-1401-x","article-title":"Radiotherapy and breast reconstruction: a meta-analysis","volume":"127","author":"Barry","year":"2011","journal-title":"Breast Cancer Res Treat"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2019.02.009","article-title":"A retrospective comparative analysis of risk factors and outcomes in direct-to-implant and two-stages prepectoral breast reconstruction: BMI and radiotherapy as new selection criteria of patients","volume":"45","author":"Casella","year":"2019","journal-title":"Eur J Surg Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14174223","article-title":"Comparison of outcomes following prepectoral and subpectoral implants for breast reconstruction: systematic review and meta-analysis","volume":"14","author":"M\u00e9gevand","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-019-0438-1","article-title":"The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study","volume":"120","author":"O'Connell","year":"2019","journal-title":"Br J Cancer"},{"key":"B34","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/PRS.0000000000005140","article-title":"Prepectoral breast reconstruction in the setting of postmastectomy radiation therapy: an assessment of clinical outcomes and benefits","volume":"143","author":"Sbitany","year":"2019","journal-title":"Plast Reconstr Surg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"795e","DOI":"10.1097\/PRS.0000000000004404","article-title":"The impact of mastectomy weight on reconstructive trends and outcomes in nipple-sparing mastectomy: progressively greater complications with larger breast size","volume":"141","author":"Frey","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000286666.29101.11","article-title":"Style 410 highly cohesive silicone breast implant core study results at 3 years","volume":"120","author":"Bengtson","year":"2007","journal-title":"Plast Reconstr Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1816651\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:37:44Z","timestamp":1779251864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1816651\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":36,"alternative-id":["10.3389\/fonc.2026.1816651"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1816651","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"article-number":"1816651"}}