Prepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in “Thin Patients”

Background : Prepectoral direct-to-implant reconstruction with ADM represents a safe, fast and successful option in breast reconstruction in a selected cohort of patients. Nowadays, this procedure is considered challenging in thin. Meanwhile, his cohort have not been accurately analyzed yet. Methods : A single institution retrospective cohort study was performed between January 2019 and March 2023 in all women who underwent mastectomy. Biometrical and clinical data were recorded. Also surgical technique, operating room (OR) time, mastectomy weights, implant choice and acellular dermal matrix (ADM) types were properly noted. Post-operative complications represented the main topic: these were classified into early and late ones based on onset time. At least 12-months follow-up was required. A comparison between thin and ideal BMI population was performed. Results : Early complications did not seem to differ between the two groups with 37.8% and 38.9% women having at least one early complication in thin and ideal weight women, respectively (P=.919). In univariable regression analysis, compared with women with BMI of 22.1-25.0, women with BMI ≤ 22.0 were associated with an increased risk of late complications of 2.84 (1.13-7.14). Specifically, thin women appeared to have a 3-fold increased risk (OR=2.97, 95% CI 1.08-8.18) of ripples/wrinkles compared with women with ideal weight. Conclusions : Pre-pectoral reconstruction with ADM in thin patients may be considered as safe as in standard BMI patients. Rippling may be more frequent, but, whenever needed, easy to correct with few sessions of lipo-grafts.