Is Lipofilling Predictable? Factors Associated with Delayed Lipofilling for Rippling After Prepectoral Direct-to-Implant Breast Reconstruction

Background Implant based reconstruction is the most common method of reconstruction in the United Kingdom (UK) for women having a mastectomy for breast cancer or as a risk reducing procedure. Prepectoral reconstruction with full implant coverage using an acellular dermal matrix (ADM) – BRAXON - is a relatively new technique. Prepectoral reconstruction has the advantages of a better aesthetic outcome, less postoperative pain, quicker return to normal activities and no postoperative problems with animation. We report on the outcomes of prepectoral immediate breast reconstruction (IBR) using Braxon®ADM from a National audit. Methods A retrospective multi-centre audit of all direct-to-implant reconstructions using Braxon®in the United Kingdom was carried out . The demographic details, treatment details, short-term and long-term outcomes were evaluated. Factors affecting complication rates were analysed. Results Data from 406 Braxon reconstructions in 324 patients across 20 centres in the UK were collated. Mean age of the cohort was 50.48 (SD – 11.11, range – 20-82) years with a mean BMI of 26.05 (SD – 4.87, range – 18-42) kg/m2. Demographic and treatment characteristics are given in Table 1. The mean follow-up period was 10.94 months (0.3 to 34.8 months). The overall complication rate was 32% with a readmission rate of 16% and an implant loss rate of 9%. Of the factors evaluated for their effect on complication rates, patient age (p = 0.005), therapeutic mastectomy (p = 0.001), specimen weight (p < 0.005) and axillary nodal clearance (p = 0.006) were significantly associated with higher complication rate on univariate analysis. Patient demographics and treatment detailsCharacteristicNumber (Percentage)Number of patients324Number of reconstructions406Mean Age (years)50.48Mean Body Mass Index (kg/m2)26.05Smoker / Ex-smoker30Indication for surgery Therapeutic mastectomy241 (74.3)Prophylactic mastectomy83 (25.6)Neo-adjuvant chemotherapy55 (16.9)Previous radiation therapy17 (5.24)Adjuvant radiation therapy55 (16.9)Adjuvant chemotherapy55 (16.9)Type of mastectomy Skin-sparing mastectomy143 (44.13)Nipple-sparing mastectomy143 (44.13)Skin-reducing mastectomy37 (11.41)Management of axilla Sentinel node biopsy207 (63.8)Axillary nodal clearance54 (16.6)No axillary surgery63 (19.4)Mean specimen weight (grams)433.24Mean implant volume (cc)374.5Complications105 (32)Implant loss36/406 (8.87) Conclusion Implant-based prepectoral breast reconstruction with Braxon®has satisfactory short-term and long-term operative outcomes, comparable to the National Mastectomy Audit data from the United Kingdom. Patient-reported outcomes, aesthetic outcomes and post operative pain need to be evaluated. Further studies with larger numbers of patients and longer follow-up have been planned. Citation Format: Chandarana M, Harries S. Prepectoral immediate implant-based reconstruction using Braxon® acellular dermal matrix – National audit from the United Kingdom [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-05.

Cosmetic Outcome after Interstitial Brachytherapy Accelerated Partial Breast Irradiation Is Related to the Location of the Lumpectomy Cavity

e21166 Background: We aimed to investigate whether a relation exists between primary tumor localization at breast and metastasis sites in breast cancer patients. Methods: Data of metastatic breast cancer patients being followed at Hacettepe University Institute of Oncology, Department of Medical Oncology between years 1987 and 2010 were analysed retrospectively. Metastasis sites and primary tumor localizations at breast were evaluated with chi-square test. Results: There were 129 (10.6%) metastatic breast cancer patients diagnosed at the admission or during the follow up period within 1,218 patients. The 13 (10%) patients had primary tumor at inner upper quadrant, 78 (60.4%) at upper outer quadrant, 11 (8.52%) at rero-areolar region, and 10 (7.75%) at inferior outer quadrant. Ten patients (7.75% ) had extensive tumors consisting of all quadrants and 4 (3.1%) had inflammatory breast cancer. The most frequent sites of metastasis were bone (n=43, 33.3%), lung (16, 12.4%) and liver (13, 10%). The 45 (34.9%) patients had metastases at multiple visceral sites. Bone and multiple visceral metastasis were the most frequent pattern of metastasis for all regions of primary tumor localizations. Isolated bone metastasis were less frequent at outer upper quadrant tumors compared to other regions of primary tumor localizations (p=0.043). Metastases at multiple visceral sites were more frequent at outer upper quadrant tumors compared to other primary tumor localizations, but statistical difference was not at significance level (p=0.106). Conclusions: It was shown that breast cancer patients had primary tumors at upper outer quadrant had less isolated bone and more frequent multiple visceral metastases.

Among 145 chest wall perforator flaps (CWPFs) performed at City Hospital, Birmingham (September 2017-February 2022), 11 were for novel indications, four were for whole breast reconstructions, two were for implant salvage procedures, three were CWPFs with skin paddle to replace excised skin/nipple-areola complex, andtwo werefor upper inner quadranttumours. Tumourcharacteristics and post-operative complications were noted. Patient-reported outcomes measures (PROMs) were measured using a questionnaire adapted from the National Mastectomy and Breast Reconstruction Audit (NMBRA) study. Among 11 patients, nine (81.81%) did not develop any complications.Ten patients responded to PROMs (median follow-up of eight months).The PROMs assessment showed that all patients (100%) were satisfied with the post-operative breast appearance. Of the patients,90% (9/10) felt the results of their surgery to be good, very good, or excellent. Of the patients, 70% (7/10) said that they have no/little persistent pain. None of the patients had difficulty carrying out normal activities. Thus, the applications of CWPFs could be extended for whole breast reconstruction, implant salvage procedures, where skin paddle is needed, and for upper inner quadrant tumours.

The use of autologous tissues is considered the mainstay for delayed breast reconstruction. Aside the free abdominal flaps, which are most commonly used, the fat-augmented latissimus-dorsi (FALD) flap has been recently shown a reliable alternative option for pure autologous breast reconstruction. In this retrospective study, we aim to compare outcomes of autologous breast reconstructions using the extended FALD and deep inferior epigastric perforator flap (DIEP) flap, with an emphasis on patients' characteristics, demographic data, complications, and patients' satisfaction after a minimum 12-month follow-up. Our series consists of 135 women who underwent a delayed postmastectomy unilateral autologous breast reconstruction from 2011 to 2017: 36 patients (Group A) had an extended FALD flap and 99 (Group B) a free DIEP flap performed by the same surgeons. Demographic data, breast volume, medical history, smoking, complications, and patients' satisfaction were recorded and analyzed. Student's t-test for independent variables, Mann-Whitney U-test, and Chi-squared test were used to compare the reported variables. Patients' age, body mass index (BMI), and pregnancy history were statistically different between groups (p < 0.001, p = 0.004, p < 0.001, respectively); younger age (35.1 vs. 41.2 years), lower BMI (25.6 vs. 28.4), and fewer pregnancies were recorded in Group A. Breast volume was also found significantly smaller in Group A patients (p = 0.009). Past medical history using the ASA physical status classification score, previous radiation therapy, history of smoking, and incidence of overall complications were similar in both groups. Overall satisfaction scores were found slightly higher, but not statistically significant, in the free-flap group (p = 0.442). The use of the FALD flap may provide comparable outcome to the DIEP flap in delayed breast reconstruction in terms of complications and patients' satisfaction; it should be considered a good reconstructive option for young and thin nulliparous patients, with small to medium size opposite breast.

Background: Immediate breast reconstruction (IBR) integrates with the surgical treatment of breast cancer, improves quality of life, psychological health and self-esteem. However, IBR following mastectomy has a higher rate of surgical complications compared to mastectomy without reconstruction, and also constitutes an independent risk factor for reoperation, which may result in delays regarding the administration of adjuvant therapies. The ideal timeframe in which to administer postmastectomy radiotherapy (PMRT) following surgery has not been well-established. The scope of this study was to evaluate whether IBR with implants has an impact on the time to start radiotherapy. METHODS: The present retrospective study reviewed 1,898 medical records of women with breast cancer submitted to mastectomy between January 2018 and December 2022 at the Aristides Maltez Hospital, a reference institution for cancer care in the state of Bahia, Brazil. Of these, 506 participants classified between stages I-III who underwent PMRT without adjuvant chemotherapy were included for analysis. The study sample was divided into two groups: women who underwent mastectomy only without reconstruction (n=416, 82.2%) and women who had undergone to mastectomy followed by IBR with subpectoral implant placement (n=90, 17.8%). The patients' demographic, oncological and surgical data were collected. Kaplan-Meier analysis with the log-rank test was used to estimate the interval from the last oncological surgical treatment until the time of the first administration of radiotherapy. Participants were additionally categorized into three groups according to the time since the onset of PMRT (≤8 weeks, &amp;gt;8 and &amp;lt;16 weeks, ≥16 weeks). Multivariable logistic regression analysis was used to explore the clinic-pathological variables hypothesized to be associated with time to start radiotherapy. Results: Most of the studied individuals were black women (n=460, 90.9%) with stage III breast cancer (n=304, 68.5%) who were treated with neoadjuvant chemotherapy (447, 88.3%). The average time of follow-up was 102.6 ±29.8 days. The median age was 49 (39-53) years old. The participants who underwent IBR were younger at surgery, more often a pre-menopausal status, fewer comorbidities, lower body mass index, no history of smoking and a higher proportion of I-II clinical stage. Kaplan-Meier analysis revealed that the IBR group started radiotherapy earlier compared to those who underwent mastectomy alone [95.84 (95% CI: 89.66, 102.03) versus 104.09 (95% CI: 101.25, 106.93) days; log-rank p=0.04)]. The proportion of women who started radiotherapy after 16 weeks was higher in the group that did not undergo breast reconstruction [164 (39.4%) versus 22 (24.4%), p=0.006]. Interestingly, mastectomy without IBR (OR=1.99; 95% CI: 1.21, 3.27; p=0.007) and hormone receptor-positive breast cancer (OR=1.71; 95% CI: 1.19, 2.48; p=0.004) were associated with a greater chance of starting radiotherapy after 16 weeks; age was not significantly associated with delayed onset of radiotherapy under regression analysis. Conclusion: The present real-world study found that patients underwent postmastectomy IBR in the absence of adjuvant chemotherapy started radiotherapy sooner than in the mastectomy without breast reconstruction group. In addition, mastectomy without IBR and hormone receptor-positive breast cancer were predictive factors for the delayed initiation of PMRT. We hypothesize that IBR could be considered a marker of higher socioeconomic status, which may explain the disparity in access to cancer treatment, even among patients treated at the same reference institution. Citation Format: Lilian Paz, Jorge Biazús. Time to postmastectomy radiotherapy in the setting of immediate implant-based breast reconstruction: does it impact on adjuvant treatment delay compared with mastectomy alone? [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-09-01.

Objective To investigate the clinicopathological features of 166 cases of invasive ductal carcinoma (IDC) of the breast and to analyze the effect of the location of the primary tumor on the prognosis of modified radical mastectomy. Materials and Methods The clinical data of 166 patients with IDC who underwent modified radical mastectomy in our hospital from May 2015 to May 2017 were retrospectively analyzed. The clinicopathological features of IDC patients were recorded. Univariate analysis and the multivariate logistic regression model were used to analyze the relationship between the location of the primary tumor and the prognosis of IDC patients after modified radical surgery. The effect of primary tumor location on the prognosis of modified radical resection was used with Survival curve analysis. Results Among the patients in the central region, 13.33% had tumors >5 cm in diameter, which was higher than those in the other four groups. Among the patients in the upper inner quadrant, 59.38% received hormone therapy after operation, which was higher than those in the other four groups (P < 0.05). There were no significant differences in age, menopause, histological grading, molecular typing, lymph node metastasis, vascular invasion, radiation therapy, and chemotherapy among different groups (P > 0.05). Univariate analysis showed that molecular typing, lymph node metastasis, vascular invasion, and location of the primary tumor were all related to the prognosis of IDC patients after modified radical surgery, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that molecular typing, lymph node metastasis, vascular invasion, and primary tumor location were all independent influencing factors for prognosis of IDC patients after modified radical surgery (P < 0.05). As of 31 May 2021, there were 11 patients with recurrence and metastasis and 20 patients with death. The median survival time in the outer upper quadrant group was 80 months, which was higher than that in the outer lower quadrant group by 72 months, the median survival time in the central region group by 71 months, the median survival time in the inner upper quadrant group by 67 months, and the median survival time in the inner lower quadrant group by 61 months. The log-rank test showed all P < 0.001. Conclusion Patients with primary tumors located in the central area have larger tumor diameters. Patients located in the central area, upper inner quadrant, and lower inner quadrant are more likely to have lymphatic metastasis, have a more serious condition, and have a shorter prognosis survival time. Unluminal type, multiple lymph node metastases, vascular invasion, and the location of the primary tumor in the inner quadrant are all independent risk factors for prognosis in patients after modified radical surgery for IDC.

Introduction: Most breast tumors respond poorly to immunotherapy. Triple-negative breast cancer (TNBC) breast tumors are thought to be more immunogenic than other breast cancer subtypes (luminal A/B or HER2+). Increased immune response in TNBC are characterized by high levels of tumor infiltrating T lymphocyte (TIL) composition that would predict excellent response to immune checkpoint blockade. For all breast cancers, tumors appear more commonly in the upper outer quadrant. However, it is not clear whether expression of immune response genes vary with tumor location among the subtypes. Here, we hypothesized that by analyzing differential gene expression associated with immune response pathways among molecular subtypes of breast cancer such as luminal A/B, HER2+ or TNBC, we can identify targetable pathways to improve therapy with breast cancer. Methods: Using the Cancer Genome Atlas (TCGA) dataset, we have identified 918 breast cancer tumor samples and compared RNAseq gene expression based on molecular subtypes and anatomic locations of biopsies (i.e., right, left, lower inner quadrant, lower outer quadrant, upper inner quadrant or upper outer quadrant). Genes with significantly different expression (p&amp;lt;0.01) were selected for survival analysis. R, Reactome Pathway Browser were used to retrieve and analyze data. Results: In TNBC, tumors from lower outer quadrant, lower inner quadrant demonstrated significantly higher CD8B mRNA expression compared with luminalA/B and HER2 (p=2.93E-04, 2.73E-04) from same locations. CD8B mRNA was not significantly higher in TNBC tumors of other sites compared with luminalA/B and HER2. However, pathway/genes associated with CTL function remained significantly different between the different sites for TNBC compared with other subtypes. The metastasis suppressor gene, CD82, was significantly higher in TNBC samples from the right side (p=4.83E-05), lower outer quadrant (p=4.33E-05), lower inner quadrant (p=3.32E-03) and upper inner quadrant (p=4.51E-07), but this gene was not significantly expressed in the upper outer region, where tumors are prevalent. From immune pathway analysis, genes involved in the antigen activates B cell receptor pathway (p&amp;lt;0.05) were associated with overall survival (OS) in right and left sided Luminal A/B and HER2 tumors and right sided TNBC tumors. Finally, genes from pathway involved in immune-regulatory interactions between a lymphoid and a non-lymphoid cells were associated with OS in lower outer quadrant, upper outer quadrant tumors in luminal A/B and HER2 cases and right sided tumors in TNBC (p&amp;lt;0.05). Conclusion: While previous studies have reported that tumor infiltrating lymphocytes and lymphoid aggregates in tumors are associated with survival, following more complex analysis, we reveal novel genes and immune pathways that demonstrate improved survival prediction in the TCGA dataset for breast cancers. Furthermore, as expected, we confirm that different immune pathways are associated with survival in luminalA/B, HER2 and TNBC tumors. Our findings demonstrate the importance of a patient-centered approach to the treatment of patients with breast cancer. Citation Format: Shen Y, Shyu C-R, Mitchem JB, Ding F, Shajahan-Haq AN. Immunogenomic pathway and survival analysis in breast cancers based on tumor location and molecular subtypes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-09-14.

Plastic Surgery of the Breast: A 75-Year Journey.

Introduction: Invasive ductal carcinoma (IDC) is the most common type of breast malignancy, making about 75% of all breast cancer cases, usually the management for IDC contains breast-conserving therapy (BCT) which is a treatment strategy that removes the tumor while preserving as much as possible from breast tissue. There is still a debate how the tumor’s location affects survival. This study aims to evaluate survival rates for IDC patients treated with BCT alone across different breast quadrants which improves patients outcomes and inrich our medical understanding. Method: SEER Program was used to obtain the data, retrospectively. Patients diagnosed with infiltrating duct breast carcinoma treated with breast conserving therapy alone were included from (2000-2021). Patients were categorised into four groups based on the location of the tumor within the breast (upper outer quadrant , upper inner quadrant , lower inner quadrant, lower outer quadrant). All patients received BCT according to SEER breast cancer surgery codes (20-24). Relative survival rates were compared using Kaplan-Meier, log-rank analysis. IBM SPSS Statistics 27.0.1 was used to conduct the statistical analysis. Results: A total of 36443 cases of IDC and treated with BCT alone were identified. Among the groups , 9.57%(n=3491) have a tumor located in lower inner quadrant, 21.55% (n=7854) in the upper inner quadrant, 57.47% (n=20947) in the upper outer quadrant, and 11.39% (n=4151) in the lower outer quadrant .Among all tumor locations, 5- years relative survival was the highest for patients with tumors in the upper inner quadrant (95.3%), followed by upper outer quadrant (94.1%), then came Lower outer quadrant (92.5%),and lastly came lower inner quadrant (92.2%), with (p -value &amp;lt; .001). Conclusion: Overall, patients who are diagnosed with invasive ductal carcinoma and treated with breast conserving therapy only showed better survival when tumors were located in the upper inner quadrant. In contrast patients with tumors in the (lower inner quadrant) showed the lowest survival rates among all quadrants . Our findings confirm that there is a significant difference in survival rates between different quadrants, it could be an entry for several researches and to spot the light on the importance of tumor location in IDC, and different management patterns. Citation Format: Abdulah Jariri. The impact of tumor location on survival rates in invasive ductal carcinoma for patients who undergo breast-conserving therapy [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-08-30.

Factors Contributing to Survival in Patients With Anaplastic Astrocytoma: A Retrospective Study of Patients Treated at a Single Institution

Introduction Tumor location within the breast varies, with the highest frequency in the upper outer quadrant (UOQ) and lowest in the lower inner quadrant (LIQ). What is not well understood is whether tumor location is prognostic. To determine whether tumor location is prognostic, associations between tumor site and clinicopathological characteristics were evaluated. Methods The Clinical Breast Care Project database was queried to identify all patients whose tumor site- UOQ, upper inner quadrant (UIQ), central, (LIQ), lower outer quadrant (LOQ) - was determined by a single, dedicated breast pathologist between 2001 and 2013. Patients with multicentric disease (n = 122) or tumors spanning multiple quadrants (n = 381) were excluded from further analysis. Clinicopathological characteristics evaluated included age at diagnosis, ethnicity, BMI, tumor stage, grade, and size, and hormone receptor, HER2 and lymph node status. Data was analyzed using chi-square and Mann-Whitney tests for univariate analysis with multivariate analysis performed using principal components analysis and multiple logistic regression. Significance was defined as P&amp;lt;0.05. Results Of the 980 patients with defined tumor location, 30 had bilateral disease. Tumor location in the UOQ (51.5%) was higher than in the UIQ (15.6%), LOQ (14.2%), central (10.6%) or LIQ (8.1%). Tumors in the central quadrant were significantly more likely to have higher tumor stage (P = 0.003) and size (P&amp;lt;0.001), positive lymph node status (P&amp;lt;0.001), and mortality rates (P = 0.011) compared to other quadrants. Analysis within each tumor size, however, found no difference in lymph node status by tumor location. After multivariate analysis, only tumor size and lymph node status remained significantly associated with mortality. Discussion Although tumors in the central region are associated with less favorable outcome, this association was driven by significantly larger tumor size, which has been associated with positive lymph node status. Tumors in the central region are known to be more difficult to detect mammographically and the majority of tumors in this region are palpable, thus, tumor location is not an independent prognostic factor, but rather less favorable prognosis, including larger tumor size, higher grade and more lymph node involvement in the central region can be attributed to delayed diagnosis. Citation Format: Seth Rummel, Nick Costantino, Matthew T. Hueman, Craig D. Shriver, Rachel E. Ellsworth. Association of tumor location with the breast and clinicopathological characteristics. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1544. doi:10.1158/1538-7445.AM2015-1544

IntroductionTumour location within the breast varies with the highest frequency in the upper outer quadrant (UOQ) and lowest frequency in the lower inner quadrant (LIQ). Whether tumour location is prognostic is unclear. To determine whether tumour location is prognostic, associations between tumour site and clinicopathological characteristics were evaluated.Materials and MethodsAll patients enrolled in the Clinical Breast Care Project whose tumour site—UOQ, upper inner quadrant (UIQ), central, LIQ, lower outer quadrant (LOQ)—was determined by a single, dedicated breast pathologist were included in this study. Patients with multicentric disease (n = 122) or tumours spanning multiple quadrants (n = 381) were excluded from further analysis. Clinicopathological characteristics were analysed using chi-square tests for univariate analysis with multivariate analysis performed using principal components analysis (PCA) and multiple logistic regression. Significance was defined as P < 0.05.ResultsOf the 980 patients with defined tumour location, 30 had bilateral disease. Tumour location in the UOQ (51.5%) was significantly higher than in the UIQ (15.6%), LOQ (14.2%), central (10.6%), or LIQ (8.1%). Tumours in the central quadrant were significantly more likely to have higher tumour stage (P = 0.003) and size (P < 0.001), metastatic lymph nodes (P < 0.001), and mortality (P = 0.011). After multivariate analysis, only tumour size and lymph node status remained significantly associated with survival.ConclusionsEvaluation of tumour location as a prognostic factor revealed that although tumours in the central region are associated with less favourable outcome, these associations are not independent of location but rather driven by larger tumour size. Tumours in the central region are more difficult to detect mammographically, resulting in larger tumour size at diagnosis and thus less favourable prognosis. Together, these data demonstrate that tumour location is not an independent prognostic factor.

Although breast-conserving therapy (BCT) is the standard form of treatment for early-stage breast cancer, in patients with small breasts cosmetic results can be poor, especially when the lesion is located on the inner upper quadrant area. This study analyzes our use of autologous free dermal fat grafts (FDFGs) for immediate breast reconstruction. A total of 23 patients who received a partial mastectomy for an inner upper quadrant lesion from 1992 to 2006 at Kagoshima University Hospital were retrospectively divided into three groups according to the reconstructive procedure that was used for the defect after partial mastectomy: immediate reconstruction using an autologous FDFG from the lower abdomen (group FDFG); patients receiving only rotation and fixation of the parenchymal adipose tissue or gland to repair the defect (group GL); and a third group who underwent immediate reconstruction using a miniflap of the latissimus dorsi (group LD). The total duration of surgery in group FDFG was significantly shorter than in group LD (P < 0.01). The mean volume of blood lost in group FDFG was significantly lower than in group LD (P < 0.01). The breast retraction assessment (BRA) of group FDFG was significantly better than for the patients in groups GL and LD (P < 0.01). The total score using the ABNSW system for cosmetic assessment was significantly better in group FDFG than in group GL (P < 0.01). Similarly, the total score in group FDFG using the assessment by the Japanese Breast Cancer Society was significantly higher than that in group GL (P < 0.01). Immediate breast reconstruction for a defect after a partial mastectomy of an upper inner quadrant malignant lesion using FDFG can be especially useful for patients with small breasts.

Acellular dermal matrix (ADM) is frequently used during prepectoral tissue expander-based breast reconstruction. However, there has been a paucity of literature describing the experience of prepectoral reconstruction without the accompanying use of ADM. We seek to highlight our institutional experience with immediate prepectoral tissue expander placement without the use of ADM in breast reconstruction. A retrospective, single-institution review of patient records was performed to identify all patients who underwent either skin sparing or nipple-sparing mastectomy with immediate tissue expander placement without the use of ADM. Demographics including age, body mass index, comorbidities, history of smoking or steroid use, perioperative radiation or chemotherapy, intraoperative details, and complication profiles during the tissue expander stage were retrospectively collected and analyzed. At the time of tissue expander placement, all mastectomy flaps were evaluated clinically and with indocyanine green laser angiography. Postoperative outcomes were tracked. Between 2017 and 2020, 63 patients (for a total of 108 breasts) underwent either skin sparing (16%) or nipple-sparing mastectomy (84%) with immediate prepectoral tissue expander without ADM placement. Fourteen percent of breasts developed postoperative cellulitis, 19% of breasts developed skin compromise, and 5% required a postoperative revisional procedure that did not result in immediate expander explant. There was a 13% (n = 14 breasts) explant rate occurring at a mean time of 74 days. Of those breasts that developed skin compromise, 45% went on to require eventual explant. Patients in the study were followed for an average of 6.3 months. Immediate prepectoral breast reconstruction using tissue expanders without ADM offers a viable alternative to established reconstructive paradigms. The major complication rate for prepectoral reconstruction without the use of ADM (17%) was found to be comparable with our historical subpectoral tissue expander reconstruction with ADM use. Tissue expander explant rates were also comparable between the prepectoral without ADM (13%) and the subpectoral with ADM cohorts. These preliminary data suggest that immediate breast reconstruction with tissue expander placement without accompanying ADM is viable alternative in the breast reconstructive algorithm.