BACKGROUND:Studies have cited possible complications and increased fluid accumulation in implant based breast reconstruction using acellular dermal matrix (ADM). We propose a novel approach, manually meshing ADM using a skin graft mesher prior to use in expander based breast reconstruction. We investigated postoperative drain time, complication rates, pain, and length of hospital stay in meshed versus unmeshed ADM cohorts. METHODS:114 patients and 194 reconstructed breasts were included over all. Of these, 99 patients were included in the pain and post-operative length of hospital stay analysis (LOS). Independent T-test and chi-square analyses were employed for bivariate comparisons. Multiple linear regression analyses were used to further delineate impact of meshing ADM on drain time, post-operative parenteral narcotic requirements and LOS between the two cohorts. RESULTS:The meshed ADM cohort had lower overall complication rates compared to the unmeshed cohort. Multiple linear regression analyses showed meshing the ADM alone decreased drain time by 7.3 days, and decreased postoperative parenteral narcotic requirements by 77% decrease (20 mg morphine). Furthermore, it was the only significant predictor for a decrease in LOS. CONCLUSIONS:Meshing ADM significantly decreased the time needed for post-operative drains. Statistical analysis showed significantly decreased overall and minor complication rates in the meshed cohort. Meshing significantly decreased parenteral narcotic requirements, and importantly also decreased the length of stay. All of these factors bear important implications to cost and quality of care in expander based breast reconstruction.