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Skin expansion is commonly needed in order to reconstruct the breast following modified radical mastectomy. With the advent of skin-sparing and nipple-sparing techniques, expansion is no longer necessary. The natural ability of healing tissues to contract can be advantageously used to improve the outcomes of immediate prepectoral breast reconstruction.A prospective analysis of the results of 20 prepectoral breast reconstructions following skin-sparing or nipple-sparing mastectomies was performed. Reconstruction was performed using the adjustable breast implant initially underfilled with air. No acellular dermal matrix or mesh support was used. Further air was added during the follow-up office visits. Air was replaced with normal saline when the desired breast size was achieved. The adjustable implants were replaced with silicone gel implants when necessary.Contraction of the skin flap over the underfilled implant was noticed in all patients. Five patients (25%) developed a seroma, and 2 patients had hematoma of the breast pocket. Wound-edge necrosis required debridement in 2 patients (10%). Complications were all resolved without implant loss.Tissue contraction can be successfully utilized in breast reconstruction following skin-sparing and nipple-sparing mastectomy. Contraction results in thickening and elevation of the flap, eliminating the need for skin excision or the use of acellular dermal matrix. The partially filled implant functions as a spacer, preventing the flap from adhering to the underlying muscle and avoiding pressure on the skin flap.