Medical Oncologist
CION Cancer Clinics
Chest wall reconstruction with mesh and flaps | CION Cancer Clinics
After ribs or breastbone are removed for a tumour, the gap is bridged with mesh or a plate so the chest stays firm, and covered with a flap of your own muscle when skin and muscle have gone too. Which material is used depends on the size of the gap and where it sits. This page explains the choices, where a flap comes from, what it costs you, and what to watch for at home. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What do mesh and flaps actually do after chest wall surgery?
- What the gap is bridged with
- Mesh and flap, compared
- Where a flap comes from, and what it costs you
- How the reconstruction is planned
- Words you will see, in plain language
- Four things families ask us, and what is actually true
- Common questions about chest wall reconstruction
The short answer
What do mesh and flaps actually do after chest wall surgery?
Mesh gives the chest wall back its firmness. A flap gives it back its cover. When ribs or breastbone are removed, a mesh or plate bridges the gap so the chest does not sink inwards on breathing in. When skin and muscle are removed, a flap of your own living tissue is moved across to cover the repair and close the wound.
Why both are often needed together
Mesh on its own is a bridge with nothing over it. It needs healthy, well-supplied tissue on top, or the skin over it breaks down and the mesh becomes infected. That is why a large reconstruction is usually two layers: something firm underneath, and living tissue on top. A plastic surgeon often joins the cancer surgeon for the second layer.
When neither is needed
A small gap at the back of the chest, under the shoulder blade, is covered by thick muscle and bone already. It is often closed with the muscle alone. The decision depends on the size of the gap and where it sits, not on how many ribs were removed.
Your surgeon will tell you which materials are planned. Ask, because it affects what you can feel afterwards and what to watch for at home.The firm layer
What the gap is bridged with
Each material suits a different gap. Your surgeon chooses on the basis of size, position and whether the area has had radiotherapy or infection before.
Soft synthetic mesh
A woven sheet stitched under tension across the gap. Scar tissue grows into it over the following months, and it becomes part of the wall. Used for small and medium gaps, and almost always at the back.
Stiffened mesh
Mesh with a layer of hardened bone cement sandwiched inside it, shaped to the curve of the chest. Firmer than mesh alone, so it is used for larger gaps at the front and side where the chest must not sink inwards.
Titanium plates or bars
Metal bars fixed to the cut ends of the ribs, or a plate fixed across the breastbone. They give the firmest repair. They can be felt under thin skin, and very rarely they loosen or break years later.
Biological mesh
A sheet made from treated animal or donated human tissue that your body slowly replaces with its own. Chosen where infection is a worry, because it copes better than plastic mesh if the wound has problems.
Not every centre stocks it. Ask what your centre uses and why.Not sure whether this applies to you?
Ask an oncologistSide by side
Mesh and flap, compared
Mesh or plate
Flap
Replaces the firmness of the ribs or breastbone
Replaces the muscle and skin that covered them
A man-made or treated material
Your own living tissue, moved with its blood supply
One scar, over the repair
A second scar where the tissue was taken from
The main risk is infection or loosening
The main risk is the flap losing its blood supply
The living layer
Where a flap comes from, and what it costs you
A flap is a block of muscle, or muscle and skin together, that is swung across from nearby while still attached to its own blood vessels. It stays alive because those vessels stay connected. The surgeon chooses the flap nearest the gap that can be spared.
The usual choices
The broad muscle of the back is the most common, because it is large and reaches most of the side and front of the chest. The chest muscle under the breast covers the breastbone. A strip of the abdominal wall muscle reaches the lower chest. Occasionally the fatty apron inside the abdomen, called the omentum, is brought up through a small opening to cover a large or infected area. It is soft and very good at healing.
What you give up
Every flap leaves a second wound and a muscle that is no longer where it was. Losing the back muscle makes pulling the arm down and back a little weaker. Losing part of the abdominal muscle can weaken the belly wall. Most people adapt within months, and physiotherapy makes a real difference. Tell your surgeon if your work depends on heavy use of one arm, because it may change which flap is chosen.
A flap is not a cosmetic choice. It is there to keep the repair covered and infection out.Leave a number, we will call you
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Before the day
How the reconstruction is planned
Measuring the gap on the scan
The surgeon works out from the CT how much bone and soft tissue will go, and whether the gap sits at the front, side or back.
Checking the cover
Skin that has had radiotherapy, an old scar or a wound that has broken down all heal poorly. If the cover is doubtful, a plastic surgeon is asked to plan a flap in advance.
Choosing the firm layer
Small or back-of-chest gaps get soft mesh or muscle alone. Larger gaps at the front get stiffened mesh or plates. Areas with earlier infection may get biological mesh.
Explaining it to you
You should be told what will be used, where the second scar will be if a flap is planned, and what to watch for at home. If that conversation has not happened, ask for it.
On your operation note
Words you will see, in plain language
- Prosthesis
- Any man-made material used to bridge the gap: mesh, cement or plate.
- Pedicled flap
- A flap moved across while still attached to its own blood vessels. Almost all chest wall flaps are this type.
- Free flap
- A flap taken completely away from its origin and reconnected to vessels near the chest under a microscope. Used only when no nearby muscle can reach.
- Latissimus dorsi
- The broad muscle of the back, the flap most often used for the chest wall.
- Omental flap
- The fatty apron from inside the abdomen, used to cover large or infected areas.
- Seroma
- A pocket of clear fluid collecting under the wound or where the flap was taken. Common, and usually drained with a needle in clinic.
Commonly believed
Four things families ask us, and what is actually true
"The mesh is plastic, so the body will reject it."
The body does not reject mesh the way it can reject a transplanted organ. Scar tissue grows into it and holds it. What can go wrong is infection, which is why the mesh is covered by healthy muscle or a flap.
"A metal plate will set off airport scanners and stop MRI scans."
Titanium rarely triggers metal detectors and is safe in MRI machines. Carry your discharge summary when you travel and tell the MRI staff about the plate. It does not stop you having scans later.
"The flap will make the chest look normal again."
The flap's job is to cover and protect, not to restore the shape. The area will look flatter and there will be scars. For a woman who has lost the breast as well, breast shape can be discussed separately, usually much later.
"Mesh has to be removed after a few years."
It is meant to stay for life. Mesh is removed only if it becomes infected and the infection will not settle with antibiotics. That is uncommon, and it is the main reason the wound is watched so closely in the first weeks.
Questions we are asked
Common questions about chest wall reconstruction
Will I be able to feel the mesh or plate?
Sometimes, as a firm area or edge under the skin, especially if you are slim or a flap was not needed over it. It should not hurt once the wound has settled. If it starts to hurt, moves, or the skin over it becomes red, it needs to be seen.
What happens if the mesh gets infected?
Early infection is treated with antibiotics and sometimes washing out the wound. If it does not settle, the mesh may have to be removed and the gap covered with a flap alone until the area is clean. Warmth, redness, leaking fluid or fever after going home should be reported the same day.
Can I have an MRI with a plate in my chest?
Titanium plates and bars are safe in MRI scanners. Tell the radiographer before the scan and bring your discharge summary, which names the material used. The plate may blur a small area of the picture, but it does not stop the scan.
Will the flap donor site hurt more than the chest?
Often, in the first weeks. The back or the abdomen, where the muscle was taken, can be sore and tight, and a pocket of fluid sometimes collects there. That is expected and is drained in clinic if needed. The soreness settles as you start to move.
Can I lift my grandchildren afterwards?
Not in the first weeks, while the repair settles. After that, most people return to normal lifting gradually. If the back muscle was used, the arm on that side may tire sooner. Your surgeon will give you the timing for your own repair.
Is chest wall reconstruction covered by Aarogyasri or insurance?
Chest wall resection with reconstruction is a recognised cancer operation. Aarogyasri, CGHS, ECHS, EHS and cashless insurance are accepted at CION, and the materials are usually part of the package. Call the helpline with your card details and we will check the specific cover before you travel.
Who does the reconstruction, the cancer surgeon or a plastic surgeon?
The firm layer is usually placed by the cancer or chest surgeon. A large flap is often done by a plastic surgeon working in the same operation. Ask who will do each part and how often they do it together. That is a fair question at any centre.
Will the reconstruction stop me having radiotherapy later?
No. Radiotherapy can be given over mesh, plates and flaps. Skin that has been rebuilt with a flap may be more delicate during treatment, and the radiation team will plan around that. Tell them what was used so they can see it on the planning scan.
Meet the Specialists
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
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Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- Cancer Research UK — Surgery for cancer
- Macmillan Cancer Support — Surgery
- National Cancer Institute — Surgery to Treat Cancer
- NHS — Soft tissue sarcomas
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Chest Wall Resection: What Is RemovedThe operation that comes before the rebuildBreathing and Chest Movement After ReconstructionHow the repair affects breathingFlail Chest and Paradoxical MovementWhy the firm layer mattersWound, Stitches and ScarsLooking after two wounds at homeComplications and Red FlagsWhat needs same-day care
Talk to us
Been told your chest wall will need rebuilding?
Send us the scan report or call the helpline. A surgical oncologist will explain what is being proposed and which questions to put to your surgeon. One helpline serves every CION centre.