Background: In an effort to shed light on the recent resurgence of prepectoral breast reconstruction and mounting concerns regarding acellular dermal matrices (ADMs), the senior author's experience with non-ADM-assisted immediate prepectoral breast reconstruction and its associated complications are presented. Methods: A retrospective cohort study of the senior author's prepectoral breast reconstruction practice without ADM from November 2019 to May 2021 was carried out. Data regarding patient demographics, oncologic management, and surgical outcomes were recorded. Results: A total of 66 patients (88 breasts) were included, with an average follow-up of 7.8 months (SD: 5.4). Of these, 24 (36.4%) underwent immediate expander and 42 (63.6%) direct-to-implant (DTI) reconstructions. Major complications included nipple-areolar complex necrosis (2%), hematoma (3%), device exposure (2%), and periprosthetic infections (5.7%). The overall rate of implant failure was 5.7%. Minor complications included simple cellulitis (10%) and minor wound dehiscence (4.5%). Increasing implant size ( p < .005) in the DTI cohort and increasing body mass index (BMI) were associated with an increased likelihood of adverse events. Postmastectomy radiation had no effect on surgical complications. Conclusions: The authors hope that in the absence of large, prospective trials, our data demonstrate the safety of immediate prepectoral breast reconstruction without ADM. Our data demonstrate that our algorithm is particularly safe in patients with a low BMI and with an implant size <500cc in DTI reconstruction. Further large prospective studies are required to further support our data in demonstrating that foregoing ADM in immediate prepectoral reconstruction is a safe option.

Background: The popularity of aesthetic surgery is on the rise, as is patients’ expectations towards excellent surgical results. In order to meet these expectations, risk factors that hinder desired outcomes, such as smoking, need to be identified and addressed. To that end, the present study summarizes an updated systematic review focused on the effects of smoking on cosmetic surgical procedures and outcomes. Methods: A systematic review of studies comparing aesthetic surgical outcomes by procedure, between tobacco smokers and non-smokers was carried out, querying PubMed, Embase and the Cochrane databases. Data regarding surgical outcomes were extracted and meta-analyzed by a random effects model in conjunction with the Mantel-Haenszel statistical method. Results: Eighty-two studies were included in the final synthesis. Abdominoplasty/panniculectomy (n = 19 cohorts) and breast reduction (n = 27 cohorts) were the most common types of procedures included in this review. Other than mastopexy and rhinoplasty, smoking conferred a statistically significant increased risk of overall complications for all studied aesthetic procedures. Conclusions: The data demonstrates that smoking is a clear risk factor for the vast majority of aesthetic plastic surgeries studied. Although our meta-analysis suggests that smoking is not a risk factor for complications in mastopexies and rhinoplasties, these two specific analyses may have been biased, and should therefore be re-evaluated with future additional evidence. The results of this systematic review confirm the importance of smoking cessation and education relative to the outcomes of common cosmetic surgical procedures.