Background: Capsular contracture (CC) represents one of the most common complications in breast reconstruction surgery, impairing final result and patients’ well-being. The role of acellular dermal matrixes (ADM) has been widely described for the treatment and prevention of contracture. The aim of the study was to evaluate the efficacy and safety of complete implant coverage with porcine-derived ADM in preventing CC limiting complications. In addition, patients’ reported outcomes were evaluated in order to define the role of ADM in improving sexual, physical and psychosocial well-being and satisfaction. Methods: 42 patients who underwent surgical treatment of 46 contracted reconstructed breasts from May 2018th to May 2019th were collected in the two groups (ADM group vs. Control group). Results: The ADM group showed lower rate of CC recurrence and a higher rate of implant losses and minor complications. A significant difference was observed in red breast syndrome (27.3% in the ADM group vs. absent in control the group) and skin ulceration rates (18.2% in the ADM group vs. 4.18% in the control group). As for patients’ perceived outcomes, the ADM group showed a statistically significant higher postoperative Satisfaction of Breast Scale score compared to the control group. In addition, a significant difference was observed in the improvement of Physical Well-Being of the Chest Scale and the Satisfaction of Breast Scale after surgery, in favor to the ADM group. Conclusion: Complete implant coverage with ADM may reduce the risk of CC recurrence in breast reconstruction. An accurate patient selection allows minimizing complications improving patient well-being and satisfaction. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background: Breast reconstruction with implants is now the preferred procedure following mastectomies. For successful reconstruction, accurate evaluation of the patient and skin flap viability is essential. This study aimed to analyze the impact of risk factors on mastectomy skin flap necrosis (MSFN) and the effectiveness of indocyanine green angiography (ICGA) in preventing complications. Methods: Fifty consecutive patients undergoing mastectomy were divided into two groups (arms A and B) based on the method of skin flap evaluation (ICGA vs. clinical assessment, respectively). Demographic details and the risk factor incidence were collected, and complication rates were compared between the two groups. Univariate analysis was conducted to identify correlations between mastectomy skin flap necrosis and the aforementioned risk factors. Results: The two groups showed comparable demographics and incidences of risk factors. Patients in arm A exhibited a lower rate of complications and reinterventions, although no significant differences were observed. Statistical analysis revealed a significant association between BMI, implant volume, and MSFN. Conclusions: ICGA proves to be an effective diagnostic tool for assessing skin flap viability. When coupled with meticulous patient selection, it aids in preventing complications.