A Complication Analysis Of Essence Human Acellular Dermal Matrix Compared To Other Products In Prepectoral Implant-based Breast Reconstruction

PURPOSE: Acellular Dermal Matrix (ADM) is widely used in implant-based breast reconstruction. We compared postoperative outcomes of Essence, a newer human ADM, with other human ADMs in immediate prepectoral implant-based breast reconstruction. METHODS: We performed a retrospective review of patients undergoing immediate prepectoral implant-based breast reconstruction at a single institution between February 2020 and September 2025. Patients with different ADMs bilaterally and those undergoing tissue expander-based reconstruction were excluded. Demographics, comorbidities, oncologic treatments, operative details, and postoperative outcomes were compared across the three ADM cohorts. Continuous variables were compared using one-way ANOVA; post hoc two-tailed Welch t tests were used for pairwise comparisons. Categorical variables were analyzed using chi-square tests; post hoc 2×2 chi-square or Fisher's exact tests were used similarly for pairwise contrasts. For key postoperative outcomes, multivariable logistic regression was performed, adjusting for age, body mass index (BMI), smoking status, and diabetes. RESULTS: There were 487 patients eligible for comparison (Essence n=68, AlloDerm n=201, Cortiva n=218). Mean age was similar across groups (~52-54 years). Patients reconstructed with Essence had a significantly higher BMI (30.0 ± 6.6 vs 25.8 ± 5.4 and 27.3 ± 6.6 kg/m²; overall p Overall noninfectious complication rates were similar (13.2%, 13.9%, and 17.4%), as were overall infection rates (11.8%, 11.0%, and 13.3%), across Essence, AlloDerm, and Cortiva, respectively. Rates of seroma, mastectomy skin necrosis, return to the operating room, drain duration, and reconstructive failure did not differ significantly across ADMs. Hematoma was the only outcome with a significant unadjusted pairwise difference but was uncommon overall (Essence 0% [0/68], AlloDerm 3.0% [6/201], Cortiva 6.0% [13/218]); on post hoc testing, Cortiva had higher hematoma rates than Essence (p = 0.043). Minor infections were also uncommon (Essence 8.8% [6/68], AlloDerm 3.0% [6/201], Cortiva 4.1% [9/218]); on multivariable analysis, the only significant adjusted association was higher odds of minor infection with Essence compared with AlloDerm (p = 0.014). CONCLUSION: Essence ADM use in immediate prepectoral implant-based breast reconstruction was associated with outcomes comparable to other human ADMs. Complication and reconstructive failure rates were similar despite use in a higher-risk cohort. These findings support Essence as a reasonable alternative ADM for prepectoral reconstruction.