Comparing breast implant support approaches with GalaFLEX™ and acellular dermal matrix in prepectoral direct-to-implant breast reconstruction

Background: Prepectoral direct-to-implant (DTI) breast reconstruction is commonly performed with adjunct implant support products to optimize surgical outcomes. While products that provide breast implants with positional support are utilized with increasing frequency, a dearth of rigorous studies comparing synthetic to biologic products remains. We sought to compare outcomes of two implant support strategies: acellular dermal matrix (ADM) alone for total anterior implant coverage versus ADM and resorbable mesh (GalaFLEX™) for complete implant coverage. Methods: A retrospective cohort design was utilized to compare the surgical costs and complications (primary clinical outcome of interest - implant malposition) among patients undergoing immediate prepectoral DTI breast reconstruction with either ADM alone or ADM + GalaFLEX™ between 2019 and 2024. All patients received smooth, round, silicone implants. Outcomes at 6 months postoperatively were analyzed. Results: 170 breasts underwent DTI reconstruction with ADM alone and 168 breasts with ADM + GalaFLEX™. Patients with ADM + GalaFLEX™ had significantly lower rates of implant malposition (1.8% vs 7.1%, p=0.031). On survival analysis, the chance of malposition with ADM alone was found to be 7.7 times higher than with ADM + GalaFLEX™. Despite these findings, revision surgery frequency was no different between groups. When comparing ADM + GalaFLEX™ to ADM alone, index operating room costs were significantly less in the ADM + GalaFLEX™ cohort. Conclusions: Utilizing ADM + GalaFLEX™ for complete implant coverage in immediate prepectoral DTI breast reconstruction is associated with lower cost and a decreased incidence of implant malposition compared to total anterior coverage with ADM alone.