Background <p>Subpectoral breast reconstruction following mastectomy requires adequate soft tissue coverage to prevent prosthetic complications such as extrusion, capsular contracture, and poor aesthetic outcomes. The suspensory ligament of the axilla (SLA), a fascial structure often overlooked, may offer a novel autologous solution for complete implant coverage without the morbidity or cost associated with acellular dermal matrices or synthetic mesh.</p> Methods <p>This study assessed postoperative outcomes and complication rates in patients undergoing alloplastic breast reconstruction utilizing the SLA as an adipo-fascial flap for total subpectoral coverage. Twenty patients (24 breasts) underwent immediate reconstruction with the SLA technique between January 2018 and January 2024.</p> Results <p>The cohort had an average age of 49 years and a mean follow-up duration of 12 months. A total complication rate of 16.6% was observed, including 8.33% minor complications and 8.33% major complications. No cases of skin flap necrosis, implant extrusion, hematoma, or donor site morbidity were reported. Patient satisfaction based on informal self-reporting during follow-up was generally high, with 75% reporting their aesthetic outcome as very good.</p> Conclusion <p>Early findings suggest the SLA-based subpectoral reconstruction technique may offer a safe, cost-effective alternative for achieving total prosthetic coverage. It eliminates the need for foreign materials, preserves muscle function, and demonstrates a low complication rate. While early outcomes are promising, prospective studies with larger cohorts are needed to further validate its long-term efficacy and safety.</p> Level of evidence <p>Level IV, therapeutic study.</p>