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The Spectrum adjustable saline implant is optimal for prepectoral breast reconstruction as it can be placed virtually empty and thus flat, applying no pressure on the overlying skin flap. However, when saline is added, it tends to pool at the bottom of the implant resulting in its uneven surface and rippling. Air filling results in the uniform distribution within the implant shell and smooth even implant surface, which facilitates acellular dermal matrix adhesion. Pressure to the skin flap is averted, patients are more comfortable, and rippling is not seen.