Direct-to-implant breast reconstruction: retrospective analysis of 91 consecutive cases

Implant-based reconstruction is the main post-mastectomy reconstructive method. With the introduction of acellular dermal matrices (ADM), direct-to-implant reconstruction has, in selected patients, replaced dual-stage technique with tissue expander. The objective of this study is to compare postoperative outcomes and quality of life of three DTI breast reconstruction techniques: pre-pectoral with ADM versus submuscular without ADM versus submuscular with ADM (dual plane). A retrospective study was conducted between January 2020 and April 2023. The enrolled patients were divided into three groups: patients who underwent mastectomy and pre-pectoral reconstruction with ADM (group A); patients treated with submuscular reconstruction without ADM (group B); and patients who underwent submuscular reconstruction with ADM (group C). Minor and major complications, revision rates, and capsular contracture rates were recorded, and patients underwent the BRECON-31 postoperative questionnaire. A total of 27 pre-pectoral reconstructions with ADM, 41 submuscular reconstructions without ADM, and 23 dual-plane reconstructions with ADM were performed. The incidence of major complications (p = 0.076) and severe capsular contracture (p = 0.048) was higher in group C. Group C achieved lower results than other groups for all BRECON-31 categories except for Recovery category. According to the study findings, the direct-to-implant breast reconstruction showed to be effective; however, the pre-pectoral technique with ADM does not seem to have superiority over the conventional muscle-pocket technique in terms of reducing complication rate and overall patient satisfaction. Level of evidence: 4.