Casella D, et al. - Analyzing a series of 397 patients, researchers compared risk factors and outcomes between patients undergoing direct to-implant (DTI) and patients undergoing two-stages expander-assisted (TSE) prepectoral breast reconstruction (PBR) in this retrospective comparative analysis. They included 521 breasts in the analysis, with an average follow-up of 38 months. Two hundred ten patients underwent DTI and 187 TSE PBR. They observed a higher risk of developing a surgical complication in DTI PBR in notable correlation with lower body mass index (BMI) and adjuvant radiotherapy. Patients at the lowest BMI with DTI were at higher risk for developing an aesthetic complication. This analysis emphasizes the careful selection of candidates for PBR and presents new selection criteria for subcutaneous techniques.