Long-term oncologic safety of one-stage direct-to-implant immediate breast reconstruction without the use of acellular dermal matrix

Aim: This study aimed to evaluate the oncologic safety of direct-to-implant immediate breast reconstruction without the use of an acellular dermal matrix (ADM) or mesh following nipple-sparing and skin-sparing mastectomy in patients with primary breast cancer. Materials and Methods: The medical records of 175 patients who underwent one-stage direct-to-implant breast reconstruction following mastectomy at the Istanbul University Oncology Institute between 2014 and 2022 were retrospectively reviewed. The primary objective was to assess the oncologic safety, including locoregional recurrence, distant metastasis, and survival outcomes. The secondary objective was to evaluate reconstruction-related complications. Results: The median age of the patients was 44 years (range: 25-74), with a median follow-up period of 53 months (range: 19-101). HR+/HER2-, HR+/HER2+, and pure HER2+ subtypes were observed in 101 patients (57.7%), 26 (14.9%), 23 (13.%), respectively. Triple-negative breast cancer was present in 16 patients (9.1%). Neoadjuvant chemotherapy was administered to 87 patients (49.7%), with a pathological complete response (pCR) rate of 17.2%. Skin necrosis (9.1%) and capsular contracture (8.6%) were the most common complications, with implant loss occuring in seven patients. Locoregional recurrence and distant metastasis rates were 9.7% and 13.1%, respectively. The five-year locoregional recurrence-free survival and distant metastasis-free survival rates were 95.4% and 90.3%. Additionally, 83.5% of patients reported their satisfaction as "excellent" or "good." Conclusion: One-stage direct-to-implant immediate breast reconstruction without the use of an acellular dermal matrix or mesh is oncologically safe, with acceptable complication rates, making it a viable alternative to two-stage breast reconstruction or conventional mastectomy.