Abstract
<title>Abstract</title> <p>Introduction: Nipple-sparing mastectomy (NSM) combined with implant-based breast reconstruction using minimally access breast surgery techniques has become increasingly adopted approach in managing early-stage breast cancer. Although acellular dermal matrix (ADM) or synthetic mesh has been proposed to confer benefits in pre-pectoral reconstruction, its routine use remains controversial. This study aimed to evaluate the feasibility and outcomes of pre-pectoral direct-to-implant breast reconstruction (DTIBR) without ADM or mesh supplementation. Methods This was a single-institution retrospective study of patients who underwent robotic- or endoscopic- assisted single-axillary-incision NSM for pre-pectoral DTIBR without ADM or synthetic mesh between January 2024 and February 2026. Surgical outcomes and short-term aesthetic results were evaluated. Results A total of 44 MA-NSM DTIBR procedures were performed in 39 patients, with a mean age of 50 years. The mean follow-up duration was 15 months. Overall complications rate was 36.4% (n = 16) with two cases (4.5%) developing partial skin flap and nipple–areolar complex (NAC) necrosis. All complications were minor (Clavien-Dindo class I) and resolved after standard medical care. No implant loss occurred. Two patients (4.5%) developed rippling. Baker grade III and grade IV capsular contracture were detected in one (2.2%) and two (4.5%) patients respectively. No surgical intervention was required. 96.9% of patient reported ‘satisfied’ with their aesthetic outcome. One (2.3%) patient with malignant phyllodes cancer developed local recurrence. Conclusion Pre-pectoral DTIBR without ADM or synthetic mesh via single-axillary-incision MA-NSM approach is feasible and demonstrates an acceptable complication profile, with favourable short-term aesthetic outcomes.</p>