Analysis of Essence Human Acellular Dermal Matrix Compared With Other Products in Prepectoral Direct-to-implant Reconstruction.

BACKGROUND: Acellular dermal matrices (ADMs) are widely used in implant-based breast reconstruction, with outcomes potentially varying across human-derived products. With the availability of newer ADMs, this study compares outcomes among different ADMs used in direct-to-implant (DTI) reconstruction. METHODS: We prospectively reviewed patients undergoing immediate prepectoral DTI at a single institution (February 2020-September 2025). We compared early postoperative outcomes (within 90 d) among 3 human ADM products (Essence, AlloDerm, and Cortiva). Analyses were performed per patient. Cohorts were compared using univariate tests; multivariable logistic regression adjusted for age, body mass index, smoking, diabetes, radiation exposure, chemotherapy exposure, mastectomy type, and total resection weight. RESULTS: A total of 487 patients were included (Essence, n = 68; AlloDerm, n = 201; Cortiva, n = 218), with similar mean age across groups (~52-54 y). Mean implant size differed across cohorts (P = 0.044), with no significant adjusted pairwise differences. The Essence cohort had higher body mass index, more prior radiation and chemotherapy exposure, higher rates of smoking, and greater total resection weight than the other cohorts (all P ≤ 0.02). Overall noninfectious complication rates (13.2%, 13.9%, and 17.4%) and infection rates (11.8%, 11.0%, and 13.3%) were similar across Essence, AlloDerm, and Cortiva groups, respectively. Seroma, mastectomy skin necrosis, drain duration, and reconstructive failure did not differ significantly. On adjusted analysis, there were no significant differences among the cohorts for any modeled postoperative outcome. CONCLUSIONS: Essence ADM demonstrates comparable safety and outcomes compared with other human ADMs for immediate prepectoral DTI reconstruction despite its use in higher risk patients.