INTRODUCTION: Immediate, implant-based breast reconstruction has become increasingly popular as a single-stage procedure with prepectoral placement of the implant following the introduction of biologic matrices. Only a few studies have described the use of bovine pericardium matrixTutomesh, a xenograft derived from bovine pericardium - and the use of laser-assisted indocyanine green angiography (ICG-A) to assess skin flap perfusion. METHODS: All patients who underwent a mastectomy followed by immediate reconstruction using prepectoral direct-to-implant with bovine pericardium from July 2019 to June 2021 were included. Complications were registered using the Clavien-Dindo classification. Postsurgical Complications were analysed with multivariate logistic regression and feature selection. RESULTS: A total of 81 prepectoral breast reconstructions were performed in 56 patients. The overall complication rate was 38.2%, and 14.3% required reoperation. Implant loss occurred in 3.7%. Multivariate logistic regression analysis demonstrated a statistically significant association between the risk of skin necrosis and previous breast surgery (p = 0.020) along with an increasing risk of implant rotation with increasing age (p = 0.010). The median follow-up was 9.9 months, and 11.1% of the breast reconstructions required postsurgical aesthetic correction. CONCLUSIONS: bovine pericardium may be used in prepectoral breast reconstruction with a good outcome. Careful patient selection is crucial, and ICG-A is helpful in reducing the risk of post-surgical Complications. FUNDING: None. TRIAL REGISTRATION: Not relevant.
