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

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.