Over the past decades, due to the increasing incidence of breast cancers and the rapid advances achieved in biomaterials science, a variety of biological and synthetic meshes have been developed for implant-based breast reconstruction immediately after mastectomy. The mesh-based procedure of breast reconstruction simplifies surgical procedures, reduces postoperative complications, and improves the aesthetic outcomes. We have systematically searched 8 medical literature databases on the complications of breast reconstruction immediately after mastectomy with the use of biological or synthetic meshes in support of prosthetic implants or tissue expanders. This review included a total of 86 clinical studies that met the screening criteria and were published from 2005 to 2021. We reviewed the incidences of major and overall postoperative complications over 12 months or longer in a total of 17 798 breast reconstructions, which were over 10% and 30%, respectively. Major postoperative complications included implant exposure and extraction, dehiscence and skin necrosis, infection, hematoma and seroma, which account for more than 75% of all major postoperative adverse events. There were considerable differences in the incidences of major postoperative complications between biological meshes and synthetic meshes. The use of biological meshes is associated with higher rates of dehiscence and skin necrosis, whereas the use of synthetic meshes is associated with higher rates of implant exposure and extraction. Therefore, besides the selection of proper meshes, surgeons are expected to pay more attention to the prevention and treatment of major complications.