Background: The reconstruction of large breasts carries a heightened risk profile. While skin-reducing mastectomy (SRM) techniques facilitate the correction of breast ptosis, they are frequently associated with a high incidence of vascular complications. This study compares two SRM techniques—the horizontal incision and the classic inverted T incision—by examining their clinical and surgical outcomes. Methods: We retrospectively analyzed data from 24 patients (30 breasts) who underwent SRM with immediate prosthetic reconstruction between 2019 and 2023 at the European Institute of Oncology in Milan, Italy. Our comparison focused on breast aesthetic outcome, reconstruction quality, complication rates (early and late), and patient satisfaction, utilizing the BREAST-Q questionnaire to gauge the latter. Results: Among the 24 patients included in the study, 16 (20 breasts) were treated with the inverted T technique, and 8 (10 breasts) with the horizontal incision approach. A higher overall complication rate was observed with the inverted T technique compared to the horizontal method, with early complications outnumbering late ones. The most common issues were recurrent seroma and skin necrosis leading to implant exposure. Notably, there were no cases of implant infection. Although the horizontal incision technique achieved slightly higher patient satisfaction scores, the difference was not statistically significant. Discussion: The inverted T and horizontal incision techniques each have unique benefits and drawbacks. Our findings indicate enhanced patient satisfaction and reduced complication rates with the horizontal incision technique. The selection of the technique should be customized based on the patient’s individual risk factors, tissue quality, and preferences.

Background: Breast reconstruction (BR) following mastectomy plays a critical role in restoring breast contour and improving patients’ quality of life. Acellular dermal matrices (ADMs) have emerged as valuable adjuncts in BR, providing structural support and enhancing soft tissue integration. However, their radiological characteristics remain underexplored, leading to potential misinterpretation and diagnostic challenges. This study aims to evaluate the imaging features of ADM in post-mastectomy patients using conventional imaging modalities, identifying its temporal evolution and clinical implications for radiologists and surgeons. Materials and Methods: This single-centre retrospective study included breast cancer patients who underwent mastectomy followed by ADM-assisted BR. Patients were monitored using standardised radiological follow-up protocols, including digital mammography (DM) and ultrasound (US), at 6 (T0), 12 (T1), and 18 months (T2) postoperatively. The primary outcomes assessed were the presence and evolution of ADM-related imaging findings, differentiation between normal ADM integration and pathological changes, and the role of different imaging modalities in ADM evaluation. Results: Sixty-three patients met the inclusion criteria and underwent radiological follow-up. At T0, ADM was identified in 16% of cases, primarily as a peri-capsular hypoechoic thickening on US and a linear peri-implant density on DM. At T1, these findings were partially resolved, with 11% of cases still displaying peri-capsular changes. By T2, imaging signs of ADM were further reduced, with only 7% of cases showing residual peri-capsular thickening or pseudonodular formations. No ADM-related complications, graft rejection, or implant loss were detected. These findings suggest a progressive integration of ADM into the host tissue over time, with characteristic imaging changes that must be recognised to avoid misdiagnosis or unnecessary interventions. Conclusions: ADM exhibits a dynamic radiological evolution in post-mastectomy BR, with its imaging characteristics gradually fading. Recognising these features is critical for radiologists and surgeons to ensure accurate interpretation and optimised patient management. A structured imaging follow-up protocol, incorporating US as the primary modality and MRI in cases of inconclusive findings, is recommended to improve diagnostic accuracy. Future multicentre studies with extended follow-up and advanced imaging techniques are necessary to refine radiological criteria and further explore ADM integration patterns. A multidisciplinary approach is essential to enhance clinical decision-making, reduce unnecessary interventions, and optimise patient outcomes in ADM-assisted BR.