Inclusion Criteria:  Female patients age 22 to 75 undergoing unilateral or bilateral immediate pre-pectoral reconstruction with tissue expanders Prophylactic and oncologic mastectomies are both acceptable Nipple sparing and skin sparing mastectomy techniques are both acceptable  Exclusion Criteria:  Intraoperative assessment demonstrates unfavorable conditions (ie poor mastectomy skin flap thickness or viability) for immediate pre-pectoral reconstruction in any breast Bilateral reconstruction patients undergoing contralateral submuscular reconstruction Direct-to-implant reconstruction Pregnancy Delayed reconstruction