Expanded prepectoral implant-based breast reconstruction: Long-term outcomes of the ray method.

BACKGROUND: Extended acellular dermal matrix (ADM) wrapping has been introduced to improve implant coverage and soft-tissue support in prepectoral breast reconstruction. We report the long-term clinical outcomes of an extended ADM configuration, termed the Ray method. METHODS: We retrospectively reviewed 224 patients (232 breasts) who underwent skin- or nipple-sparing mastectomy followed by immediate prepectoral implant-based reconstruction using the Ray method between February 2020 and August 2023. Mean follow-up was 24.3 months (range, 6-67 months). Complications, including wound dehiscence, seroma, hematoma, flap necrosis, capsular contracture, infection, implant rupture, and implant failure, were analyzed per breast. RESULTS: Wound dehiscence occurred in 9.1% and seroma in 9.1% (major 3.0%). Flap necrosis was reported in 0.4%, hematoma in 0.9%, and infection in 0.9% of the breasts. Clinically significant capsular contracture (Baker grade III/IV) was observed in 2.2% of breasts. Implant failure rate was 1.3% (3 breasts). No implant rupture occurred during follow-up. CONCLUSIONS: The Ray method provides complete implant coverage and additional structural support to the superior and periprosthetic regions, resulting in acceptable long-term complication rates and stable contour restoration in immediate prepectoral breast reconstruction.