Breast reconstruction after surgery for cancer has more and more become crucial for patients’ satisfaction and quality of life. Lately, thanks to the spread of medical devices like synthetic and biological meshes (Acellular Dermal Matrices: ADMs) and surgical techniques such as skin-sparing and nipple-sparing mastectomies, surgeons are allowed to perform immediate breast reconstruction, avoiding the use of tissue-expanders. ADMs-assisted breast reconstruction can be divided into prepectoral and submuscular dualplane technique. In the last decade, many surgeons adopted the prepectoral technique, in order to avoid the direct contact between the silicone implant and the host tissues and complications such as animation deformity, muscular impairment and migration of the prosthesis. ADMs create a scaffold that the host cells can colonize, thus allowing prosthetic integration and encapsulation and promoting at the same time new vascularization. We performed a brief review of the literature about the use of ADMs in prepectoral direct-to-implant breast reconstruction, also discussing about the costs and their impact on the healthcare system, and finally mentioning which may be the direction of future technology in this promising field of research.