Prepectoral breast reconstruction with complete anterior implant coverage using a single, large, square-shaped acellular dermis matrix

Background: Several studies have discussed various methods of prepectoral direct-to-implant (DTI) breast reconstruction using an acellular dermis matrix (ADM) prosthesis to achieve full coverage; however, methods for anterior coverage are rarely reported. In this study, prepectoral DTI breast reconstruction with complete anterior implant coverage was performed using a square piece of ADM. This study aimed to introduce our prepectoral DTI technique and to identify its functional and cosmetic outcomes compared with existing subpectoral DTI techniques. Methods: Our prospective cohort study focused on 29 patients (35 breasts) and 34 patients (35 breasts) who underwent breast reconstruction via subpectoral implant insertion (control) and anterior coverage prepectoral implant insertion, respectively. Postoperative complications were observed, and breast symmetry was evaluated using the Vectra H2 three-dimensional scanner. The modified Kyungpook National University Hospital Breast-Q (KNUH Breast-Q) was used to evaluate the patient’s subjective satisfaction with the reconstruction and postoperative quality of life. Results: There were no significant differences in complications in either group (i.e., seroma, skin necrosis, nipple–areola complex necrosis, hematoma, capsular contracture, and infection). Statistically significantly better results were found in the anterior coverage group in the mean drain removal period. As compared with controls, the anterior coverage group had greater symmetry on three-dimensional scan, but this was not statistically significant. Subjective satisfaction and postoperative quality of life measured using the KNUH Breast-Q scale were not significantly different. Conclusions: Considering its stability, faster recovery time, and cosmetic advantage, prepectoral breast reconstruction with anterior implant coverage using a single, large ADM is a good option in performing breast reconstruction with implant insertion in patients who have undergone mastectomy. Level of Evidence: Level II, Prospective cohort study.