Highlight
1. Prepectoral direct-to-implant (DTI) breast reconstruction demonstrated significantly lower major and minor complication rates than traditional two-stage implant-based breast reconstruction (IBBR).
2. Patients undergoing DTI required fewer overall surgeries, averaging 1.2 per breast, compared to 2.3 in two-stage approaches.
3. Although aesthetic revisions were more frequent with DTI, these were primarily minor, elective procedures such as fat grafting.
4. This study provides the largest dataset focused exclusively on prepectoral reconstruction, offering plane-specific insights for surgical planning and patient counseling.