OBJECTIVE: The aim of this study was to report the results of prepectoral direct-to implant (DTI) reconstruction in nipple-sparing mastectomy (NSM), without acellular dermal matrices (ADM) or mesh. METHODS: Multicenter cohort of patients, from 2013 to 2020, where all sizes and types of breasts, either for prophylactic or therapeutic surgical purposes were included, except those with previously failed reconstruction, previous radiotherapy with severe skin damage, locally advanced breast cancer, gigantomasty, severe degree of ptosis, tumors closer to NAC (<1cm on MRI), and combined autologous-based reconstruction. RESULTS: 280 immediate breast reconstructions were performed in 195 patients. The mean age was 45, and 32.8% were post-menopausal. The mean follow-up was 16.5 (±17.43) months. Eighty-five (43.6%) underwent bilateral mastectomy; 116 (41.4%) mastectomies were prophylactic and 164 (58.6%) were therapeutic. Sixty-eight (24%) reconstructions had at least one acute complication, the most common was implant explantation (9.2%), which were more frequent in smokers. Late complications like rippling grades III and IV, were observed in 7 (3.8%) cases, capsular contracture Baker II-IV in 29 (15.7%), being 22 as Baker II (11.9%), 6 Baker III (3.3%) and 1 Baker IV (0.5%). One implant rotation was observed. No deformity animation was observed. Cosmetic results were considered good or excellent in 87.3%. CONCLUSIONS: Overall complications were like ADM, mesh, or subpectoral reported series, except by a higher explantation rate. This technique is safe and economically advantageous, as it is a one-stage technique without ADM and mesh. However, this is a preliminary data and larger and comparative studies are required.
OBJECTIVE: The aim of this study was to report the results of prepectoral direct-to implant (DTI) reconstruction in nipple-sparing mastectomy (NSM), without acellular dermal matrices (ADM) or mesh. METHODS: Multicenter cohort of patients, from 2013 to 2020, where all sizes and types of breasts, either for prophylactic or therapeutic surgical purposes were included, except those with previously failed reconstruction, previous radiotherapy with severe skin damage, locally advanced breast cancer, gigantomasty, severe degree of ptosis, tumors closer to NAC (<1cm on MRI), and combined autologous-based reconstruction. RESULTS: 280 immediate breast reconstructions were performed in 195 patients. The mean age was 45, and 32.8% were post-menopausal. The mean follow-up was 16.5 (±17.43) months. Eighty-five (43.6%) underwent bilateral mastectomy; 116 (41.4%) mastectomies were prophylactic and 164 (58.6%) were therapeutic. Sixty-eight (24%) reconstructions had at least one acute complication, the most common was implant explantation (9.2%), which were more frequent in smokers. Late complications like rippling grades III and IV, were observed in 7 (3.8%) cases, capsular contracture Baker II-IV in 29 (15.7%), being 22 as Baker II (11.9%), 6 Baker III (3.3%) and 1 Baker IV (0.5%). One implant rotation was observed. No deformity animation was observed. Cosmetic results were considered good or excellent in 87.3%. CONCLUSIONS: Overall complications were like ADM, mesh, or subpectoral reported series, except by a higher explantation rate. This technique is safe and economically advantageous, as it is a one-stage technique without ADM and mesh. However, this is a preliminary data and larger and comparative studies are required.