Prepectoral Breast Reconstruction Without Acellular Dermal Matrix and Mesh: A Prospective Cohort Study

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Oncology

Background:

• Limited long-term data exists for prepectoral implant reconstruction without acellular dermal matrix (ADM) or mesh.
• This study provides long-term follow-up on prepectoral direct-to-implant reconstruction outcomes without ADM or mesh.

Purpose of the Study:

• To evaluate the long-term outcomes of prepectoral direct-to-implant breast reconstruction.
• To assess the safety and efficacy of this technique without ADM or mesh.

Main Methods:

• Retrospective review of patients undergoing nipple-sparing mastectomy with immediate prepectoral implant reconstruction (2018-2025).
• Exclusion of patients with locally advanced breast cancer or tissue expander reconstruction.
• Analysis of complication rates, implant loss, capsular contracture, rippling, and patient satisfaction.

Main Results:

• 32 reconstructions in 25 patients with a median follow-up of 38.5 months.
• Implant loss in 6.2% of cases (smokers); capsular contracture in 4 radiated breasts.
• High overall patient satisfaction rate of 90.6%.

Conclusions:

• Prepectoral direct-to-implant reconstruction without ADM or mesh is technically simpler, less costly, and yields favorable outcomes.
• Complication rates are acceptable, with excellent results in non-radiated patients.
• Radiotherapy should not be an absolute contraindication for this reconstruction method.