Short-Term Outcomes of Post-Mastectomy Immediate Pre-Pectoral Reconstruction with Implant and Acellular Dermal Matrix

Introduction: Pre-pectoral breast reconstruction using implant and acellular dermal matrix (ADM) has become one of the main techniques for immediate reconstruction after mastectomy, with variable approaches and complication rates reported in literature. This study aims to evaluate the early outcomes of this technique, at a single tertiary oncology center. Methods: We performed a retrospective analysis of a prospectively maintained database including women who underwent immediate pre-pectoral reconstruction with implant and ADM following mastectomy between January 2021 and August 2023. The primary outcome was reconstructive failure within 3 months, defined as the need for removal of the implant placed during the index surgery. Secondary outcomes included complications at 3 months and predictive factors for complications. Results: A total of 247 reconstructions were performed in 200 patients, 83.4% following oncological mastectomy and 16.6% after risk-reducing surgery. The median age was 49 (43-56) years; 15.5% of patients were obese and 26.5% were active smokers. Skin-sparing mastectomy was performed in 16.6% and nipple-sparing in 83.4%, with a Wise-pattern incision in 73.3%. Reconstructive failure occurred in 7.7%, with one case (0.4%) of total reconstruction loss. The overall complication rate was 14.6%-skin flap ischemia occurred in 12.6%, primary implant infection in 2.0% and bleeding in 0.8%. The reoperation rate was 8.4%. No predictive factors for complications were identified. Conclusions: In this series, including a high proportion of high-risk patients, immediate pre-pectoral reconstruction with implant and ADM appears safe, with a low rate of early complications. No predictive factors for complications were found, supporting widening its indications.