EXpander-based Versus Direct to Implant PRE-pectoral Breast Reconstruction: a Comparative Analysis of Surgical Outcomes

EXpander-based Versus Direct to Implant PRE-pectoral Breast Reconstruction: a Comparative Analysis of Surgical Outcomes : the EXPRESsO Study

Recent advances in breast surgery, together with the increasing adoption of conservative surgical approaches, have renewed interest in pre-pectoral implant-based breast reconstruction. Within this reconstructive paradigm, surgeons may employ two distinct strategies:

(i) immediate reconstruction using a direct-to-implant approach (DTI), or (ii) a two-stage reconstruction consisting of tissue expander placement followed by definitive implant insertion (TE-I).

Each approach is associated with specific indications, advantages, and inherent limitations.

The EXPRESSO study aims to retrospectively compare surgical outcomes between pre-pectoral DTI and TE-I breast reconstruction. By providing real-world evidence on these reconstructive strategies, this study seeks to inform surgical decision-making and to optimize reconstructive outcomes in contemporary breast cancer care.

Inclusion Criteria:

• Female patients ≥18 years

• Patients undergoing unilateral or bilateral therapeutic mastectomy for breast cancer

• Patients undergoing pre-pectoral implant-based breast reconstruction, either:

  • One-stage DTI, or
  • Two-stage TE-I

• Use of implant with or without biological or synthetic mesh

• Contralateral prophylactic mastectomy allowed if a therapeutic mastectomy was performed on one side

Exclusion Criteria:

• Male patients
• Subpectoral implant-based reconstruction
• Autologous breast reconstruction
• Delayed reconstructions not performed at the time of mastectomy
• Incomplete clinical or follow-up data for primary endpoint analysis