Prepectoral Direct-to-implant Breast Reconstruction Without ADM or Mesh: A Prospective Single-surgeon Series of 210 Patients and 349 Breasts.

Celet Ozden B, Sevindik GA, Yildirim N, Yilmaz C, Karanlik H, Gun Koplay T, Igci A.

Journal ArticleOpen access

AI summary — for doctors, generated from the abstract only

In a prospective single-surgeon series of 210 patients (349 breasts), prepectoral direct-to-implant breast reconstruction without ADM or mesh showed low total implant loss (1.1%) and high rates of good-to-excellent cosmetic outcomes, though early complications occurred in roughly a quarter of breasts.

What was studied

A prospective single-center, single-surgeon study of 210 consecutive patients (349 breasts) undergoing immediate prepectoral direct-to-implant breast reconstruction using 4-micron surface (Motiva Ergonomix2) implants without acellular dermal matrix or mesh (September 2023-March 2025), evaluating early/mid-term complications, aesthetic outcomes, and BREAST-Q patient-reported satisfaction, with median follow-up of 12 months.

Key findings

Early complications occurred in 26.1% of breasts, most commonly incision dehiscence (5.2%), hematoma (3.7%), and partial nipple-areola-complex necrosis (2.9%).
Capsular contracture (Grade III/IV) occurred in 7.7% of breasts and implant rippling in 6%; 8% of breasts required unplanned reoperation, and total implant loss occurred in 1.1%.
Cosmetic outcomes (n=143 breasts assessed) were rated 'excellent' or 'good' in over 75% of cases, approaching 92% in bilateral prophylactic mastectomies.
BREAST-Q responses (n=129) showed a postoperative breast satisfaction score of 64.96% and implant satisfaction of 6.6/8.

Clinical relevance

The findings suggest that ADM/mesh-free prepectoral reconstruction with this specific implant may be a safe option with low implant loss and satisfactory patient-reported outcomes, which may be relevant to surgeons considering cost and complication trade-offs of ADM use, though this comes from a single surgeon's experience without a comparator ADM group.

Who should care

Plastic & Reconstructive Surgery

Limitations

Single-surgeon, single-center series without a direct comparison group (e.g., ADM-assisted reconstruction); median follow-up of only 12 months limits assessment of longer-term outcomes such as later capsular contracture.

A single surgeon's series found ADM/mesh-free prepectoral direct-to-implant reconstruction had low implant loss and high patient satisfaction, though about a quarter of breasts had early complications.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Background

Prepectoral breast reconstruction reduces postoperative morbidity and eliminates animation deformity. Although acellular dermal matrices (ADM) and mesh have traditionally been used to stabilize prepectoral implants, emerging evidence has questioned their value and highlighted their association with postoperative complications.

Objectives

This study presents a single-surgeon experience using 4-micron surface implants without ADM or mesh in immediate prepectoral direct-to-implant reconstruction.

Methods

This is a prospective single-center, single-surgeon study involving patients who underwent immediate prepectoral, breast reconstruction using Motiva Ergonomix2 implants, between September 2023 and March 2025. Early and mid-term complications, aesthetic outcomes, and patient-reported satisfaction (BREAST-Q) were analyzed.

Results

A total of 210 consecutive patients (349 breasts) underwent this surgical procedure with a median follow-up of 12 months (range: 3 to 21 months). Early complications occurred in 26.1% of breasts, most commonly incision dehiscence (5.2%), hematoma (3.7%), and partial nipple-areola-complex (NAC) necrosis (2.9%). Capsular contracture (Grade III/IV) occurred in 7.7% and implant rippling in 6%. Twenty-eight breasts (8%) required unplanned reoperation. Total implant loss occurred in 1.1% of breasts. Cosmetic outcomes (n=143) were rated "excellent" or "good" in >75% of cases, approaching 92% in bilateral prophylactic mastectomies. BREAST-Q responses (n=129) demonstrated a postoperative breast satisfaction score of 64.96%, and implant satisfaction of 6.6/8.

Conclusions

This technique demonstrates low complication and implant loss rates, satisfactory aesthetic results, and high patient-reported satisfaction. These findings support Ergonomix2 implants as a safe, biocompatible, and potentially cost-effective option for prepectoral reconstruction.

DOI

10.1093/asj/sjag191

PMID

42721297

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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