Technical feasibility of hand-meshed autologous dermal grafts in immediate prepectoral breast reconstruction: a preliminary case series

Abstract

Background Prepectoral breast reconstruction offers reduced morbidity and improved aesthetic outcomes compared to traditional approaches. However, access to cost-effective and biologically compatible tissue for implant support remains limited. This case series explores the use of hand-meshed autologous dermal grafts harvested from patients as a readily available and cost-effective alternative for implant coverage.Methods Breasts underwent immediate prepectoral implant-based reconstruction using hand-meshed autologous dermal grafts, harvested from the lower abdomen, the ipsilateral breast, or the contralateral breast, in a prepectoral breast reconstruction technique referred to as harvested corium-covered implant (HACCIM). Data regarding clinical, surgical, and short-term minor and major complications were recorded and analyzed.Results Sixteen patients (21 breasts) underwent prepectoral implant-based reconstruction with autologous hand-meshed dermal grafts. The mean duration of dermal graft preparation and donor site repair was 36 min. Minor complications occurred in 10 breasts as superficial mastectomy skin flap wound events, with 4 also showing small wound dehiscence; all were managed conservatively. Major complications occurred in 2 of 21 cases: one involving a large radiation-induced skin ulcer following early postoperative radiotherapy (initiated 4 weeks after surgery), which resulted in implant exposure and eventual loss; and another involving implant loss in a patient who had received radiotherapy 18 months before reconstruction.Conclusion This case series suggests the technical feasibility of hand-meshed free dermal autograft in immediate prepectoral implant-based breast reconstruction. However, minor superficial mastectomy skin flap wound events were common, indicating a clinically relevant complication burden. Implant loss was also observed in two patients with recent pre- or postoperative radiotherapy exposure. Given the small sample size, these findings remain descriptive, and larger prospective studies are needed to further evaluate the safety, complication profile, and long-term outcomes of this approach.