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Updated: Jun 18, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Risk factors and complication predictors in prepectoral breast reconstruction using ADM and smooth round implants: An
Michail Sorotos1, Guido Firmani1, Guido Paolini1
1Chair of Plastic and Reconstructive Surgery, Sant'Andrea Hospital, NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Via di Grottarossa 1035/1039, Rome, Italy.
Background:
Prepectoral implant-based reconstruction using acellular dermal matrices (ADMs) has emerged as a viable option for immediate breast reconstruction (IBR) following mastectomy. This multicenter, prospective observational cohort study evaluated the outcomes of prepectoral reconstruction using Braxon® ADMs and smooth round implants across two specialized Italian cancer centers.
Methods:
From April 2019 to December 2024, 140 female patients (221 breasts) underwent skin- or nipple-sparing mastectomy followed by immediate prepectoral reconstruction with either Braxon® Regular or Braxon® Fast ADM and Motiva® or Mentor® implants. Comprehensive demographic, surgical, and postoperative data were collected. Complications were classified as mastectomy-related (e.g., bleeding and mastectomy skin flap necrosis) or reconstruction-related (e.g., seroma, infection, and red breast syndrome). Binary logistic regression identified predictors of complications.
Results:
The mean patient age was 48.6 years, with a BMI of 22.7 kg/m². A total of 96 complications (43.4%) were recorded: 64 were mastectomy-related (29.0%) and 32 were reconstruction-related (14.4%). Reoperation was required in 14.9% of the cases. Mastectomy flap necrosis (6.9%) and infection (3.6%) were the most frequent complications leading to implant removal in 7.4% of the cases. Logistic regression identified neoadjuvant chemotherapy (OR=18.8; p=0.026), Braxon® Fast compared to Braxon® Regular (OR=0.092; p=0.013), and extended antibiotic prophylaxis (OR=0.013; p=0.004) as predictors of reconstruction-related complications.
Conclusions:
Prepectoral IBR with Braxon® ADMs demonstrated acceptable complication rates. No predictors were associated with mastectomy-related outcomes. Braxon® Fast and prolonged antibiotics were protective against reconstruction-related events, while neoadjuvant chemotherapy increased the risk. These findings highlight the importance of patient selection and perioperative strategies, particularly in high-risk subgroups such as those receiving neoadjuvant chemotherapy.
