Objective. In the few latter, immediate breast reconstruction, performed with prepectoral positioning of implants, is assuming an increasinglly important role in the tumor recovery process for most women. With this study we want to describe our experience in prepectoral immediate breast reconstruction using Exashape, a new pre-shaped bilayer acellular dermal matrix derived from bovine pericardium. Methods. Twenty-one patients with breast cancer were enrolled and went under momo-(5) or bilateral ( 16) nipple sparing mastectomy, for a total of 37 reconstructed breasts. All the implants have been assembled with Exashape and positioned over the pectoralis major muscle. All the patient answered to BREAST-Q questionnaire in preoperative time six months after surgery. Results. This preliminary study showed a reduction of implant's exposure time and risk of bacterial contamination, a decreased risk of injury to the implant and an easy assembly and positioning. Of Twenty-one patients enrolled for this study, only five patients had complication: four resolved after surgical revision of scars and one with implant loss. BREAST-Q resulted overall satisfaction with breasts, psychosocial well-being, and sexual well-being were all significantly increased (p < 0.05) and chest discomfort got significantly worse (p < 0.05). Conclusions. Although further studies would be useful to validate our result. We can say that Exashape TM has proved to be useful in breast reconstruction, allowing a good aesthetic and functional result.