•Breast reconstruction is typically performed after a mastectomy or lumpectomy as part of breast cancer treatment, with the goal of restoring the appearance and symmetry of one or both breasts.

•From a surgical standpoint, breast reconstruction can be performed using either implant-based or autologous (“flap”) reconstruction, during or after the mastectomy/lumpectomy procedure. In implant-based reconstruction, the implant can be placed either underneath the chest muscle (subpectoral) or over it (prepectoral).

•Prepectoral implant-based breast reconstruction can be a valuable approach, contributing significantly to the recovery and overall quality of life for patients after mastectomy.

•Often, the use of acellular dermal matrix or ADM (biologically engineered scaffolding from human, bovine, or porcine sources), is employed during this procedure.

•Functionally, ADM can provide structural support, stabilize the implant, and increase soft tissue coverage. It is also useful for facilitating tissue integration, vascularization, and improving overall aesthetic outcomes.

•In recent times, the use of ADM in prepectoral breast reconstruction has been debated, with complication rates and cost-effectiveness being common areas of discussion.

•This analysis aims to offer a comprehensive cost-effective analysis of prepectoral implant-based breast reconstruction, with and without the use of ADM.

•We also aim to provide insights for surgeons, healthcare policymakers, and patients by delivering a comprehensive understanding of the factors driving the cost of prepectoral breast reconstruction, with and without ADM.