Immediate direct-to-implant ( DTI ) breast reconstruction is the method of choice utilized by many breast surgeons worldwide and preferred by most breast cancer patients, however the cost of acellular dermal matrix (ADM) and some synthetic meshes is high ,especially in a developing country. This study aimed to Establish the short-term and long-term safety of immediate implant-based breast reconstruction performed with and without a low-cost alternative mesh. In addition, Evaluate the indications, restrictions, aesthetic outcome and complication rate. Methods: This is a prospective cohort study that was conducted on sixty-six patients who underwent Nipple sparing mastectomy or Skin sparing mastectomy with immediate reconstruction by silicon implants in the National Cancer Institute, Cairo University, Egypt from December 2019 to December 2022.The Study outcomes were mainly directed to evaluate technique , Complications , aesthetic outcome. Techniques employed were either subpectoral, Prepectoral or dermal sling. The Complications were stratified into early (within) and late (after 6 months postoperatively) and further subcategorized into major or minor according to management. Aesthetic outcome was assessed using breast Q questionnaire. Results: This study included 66 patients (70 breasts) with Median age 39 years. The Median follow up was 15.6 months. The sub-pectoral technique was done for 30 patients, while 27 patients had pre-pectoral implants. Dermal sling technique was used in 9 patients. We mainly used the ultrapro mesh in 75.4 % of patients. The overall complication rate was 43%. Early complications included; full-thickness mastectomy skin necrosis (8.3%) ,infection (5.7%) ,superficial sloughing ( 7.1 % ), hematoma ( 1.4 % ) and red breast syndrome (1.4 %). Consecuently,7 implants were lost. Late complications included; Capsular contracture ( 21.4 % ) , implant extrusion (2.9 % ) and radionecrotic ulcer (1.4 % ) . 5 implants were lost in the late complication group. Radiotherapy and chemotherapy were significant risk factors for complications. Conclusion: This study demonstrates acceptable complication rate and aesthetic outcome of direct to implant breast reconstruction , even without ADM or expensive synthetic meshes , however proper patient selection is a key factor for both the success and the choice of operative technique