The role of bovine pericardium matrix in immediate prepectoral breast reconstruction: Insights from the largest published retrospective series.

Immediate prepectoral breast reconstruction (IPBR) with biological matrices is a widely adopted technique, traditionally guided by ABS-BAPRAS eligibility criteria. In Europe, their use has declined in recent years, while polyurethane-covered implants have emerged as an alternative in some centers. This study reports the outcomes of IPBR with Exaflex, a biological matrix, performed at CHUVI in a real-world clinical setting.A retrospective analysis was conducted on a cohort of 80 patients and 112 mastectomies from a prospectively maintained database. The mean patient age was 51 years, and the average BMI was 24.3 kg/m2; 21.25 % had a BMI <21 and 18.75 % were smokers. Preoperative MRI showed a pinch test >15 mm in 68.75 % of breasts. Preoperative radiotherapy was administered in 2.67 % of breasts, and 32.1 % received postoperative radiotherapy. 43.75 % of patients presented with two or more concurrent risk factors Nipple-sparing mastectomy (NSM) was the most common technique (92.9 %), and all reconstructions were prepectoral. Mean breast weight was 212.8 g and implant volume 327 cc. Axillary surgery was performed in 59 % of cases (SLNB 55.4 %, ALND 5.3 %).Complication rates included seroma (5.4 %), hematoma (8 %), wound infection (6.25 %), prosthetic infection (4.46 %), skin necrosis (7.14 %), rippling (9.8 %), and capsular contracture (2.67 %). No animation deformities were observed. Aesthetic reoperation occurred in 10.7 % of cases, and reconstruction failure in 1.78 %. Mean follow-up was 13.5 months (median 13). A statistically significant association was observed between postoperative radiotherapy and capsular contracture (p = 0.03), while no significant association was found between radiotherapy and prosthetic infection (p = 0.32), skin necrosis (p = 0,71) or rippling (p = 0.47). No significant association was found between any individual risk factor (diabetes, low/high BMI, smoking, radiotherapy, or pinch thickness <15 mm) and the occurrence of complications. Although the number of risk factors per patient (0, 1, 2, or ≥3) was not significantly associated with complication rates, a non-significant trend toward increased risk was noted among patients presenting multiple concurrent factors. Conclusion: IPBR with Exaflex is a safe and reproducible technique with favorable outcomes. The ABS-BAPRAS criteria are highly selective. However, despite the limitations of our study, our findings suggest that, in experienced hands, these criteria might be cautiously expanded to include NSM patients with selected risk factors.