Introduction <p> Implant based breast reconstruction is a widely used, patient centric option after mastectomy and while Acellular Dermal Matrix (ADM) can improve the support, its cost and limitations has driven interest in synthetic meshes. We describe outcomes of subpectoral implant Direct to implant using D-ASH (Deo-Ashutosh Synthetic Hybrid) technique using Proceed^® mesh. </p> Materials and Methods <p> A retrospective analysis was done of database at Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi was reviewed for all patients undergoing subpectoral Direct to Implant (DTI) reconstruction using Proceed® mesh. Perioperative details and postoperative complications were recorded, and patient-reported outcomes were assessed.</p> Results <p> Forty-nine patients underwent 70 subpectoral implant reconstructions; 21 had bilateral procedures (including 4 synchronous bilateral cancers and 1 BRCA1 carrier). Overall, 52 therapeutic and 18 prophylactic mastectomies were performed, comprising 41 nipple-sparing and 29 skin-sparing mastectomies. Complications were predominantly minor: wound dehiscence 5.7%, seroma 5.7%, infection 5.7%, superficial marginal flap necrosis 4.2%, and partial NAC loss 1.4%. No hematomas, major flap loss, or complete NAC necrosis occurred. One implant loss/explantation (1.5%) and one capsular contracture (Grade II) (1.5%) were observed. Minimal animation deformity (Grade I) occurred in 8.5%. </p> Conclusion <p> Subpectoral direct-to-implant reconstruction using a synthetic dual-layered Proceed® mesh (the D-ASH technique) appears to be a safe, reproducible, and reliable option in appropriately selected patients. This approach offers strong implant coverage, which is especially useful when mastectomy flaps are thin, previously irradiated, or of uncertain perfusion. In addition, synthetic mesh may provide a more cost-effective alternative to biologic ADM without compromising clinical outcome</p>