A Comparative Study of One-Stage Pre-pectoral Implant Breast Reconstruction With and Without Mesh

Background Pre-pectoral implant-based breast reconstruction has become increasingly popular because it is associated with less postoperative pain and earlier recovery than traditional sub-pectoral techniques. Acellular dermal matrix (ADM) in pre-pectoral reconstruction is thought to provide additional support for the implant and improve cosmetic outcomes. However, it leads to additional costs. This study aimed to compare the early outcomes of pre-pectoral implant-based breast reconstruction with and without mesh. Methodology An observational, single-surgeon, retrospective cohort analysis was conducted to evaluate patients who underwent one-stage pre-pectoral breast reconstruction between May 2019 and July 2023 at Royal Wolverhampton NHS Trust. Patient characteristics such as demographics, implant size, and postoperative complications were noted and compared. Statistical significance between groups was evaluated using chi-square tests, and a p-value <0.05 was deemed statistically significant. Results A total of 101 patients were included, with 52 patients with ADM and 49 patients without ADM. In total, 60 implant reconstructions were included in each group. Patients in the ADM group were younger than patients in the cohort without the mesh (median = 50 versus 56 years). Patients with ADM also had a higher median volume of breast implants than patients without mesh (430 vs. 330 cc). There were statistically more patients requiring postoperative radiotherapy in the ADM mesh group (p = 0.049). The early postoperative outcomes in both groups were comparable with no statistical differences in the rate of infection, seroma requiring aspiration, or implant loss. Conclusions This study which is one of the few studies comparing one-stage pre-pectoral implant reconstruction with and without mesh demonstrated that pre-pectoral reconstruction with no ADM is cost-effective and associated with comparable early postoperative outcomes. Our early observational series showed satisfactory outcomes; however, further studies are required to investigate longer-term and patient-related outcomes.