Purpose: The use of acellular dermal matrix (ADM) and surgical mesh is commonly used in Australia in patients undergoing breast reconstruction post-mastectomy. These materials are promoted as providing structural support, integration with surrounding soft tissue, and reduction in implant malposition. This study aims to investigate revision outcomes of reconstruction using three ADM/Mesh types (Flex®/TiLOOP®/Veritas®) and no ADM/mesh (comparator). Methodology: A registry-based cohort study of ADM/Mesh use in post-cancer/risk-reducing direct-to-implant (DTI) and two-stage (TS) procedures in Australia between 2015-2021 captured in the Australian Breast Device Registry. The revision rate for each ADM/Mesh was calculated and compared with procedures with no ADM/Mesh. Data includes descriptive patient and procedure characteristics and time-to-revision data, presented as crude and risk-adjusted survival analysis. Results: A total of 12,233 cases (6,415 DTI and 5,818 TS) were analysed. The crude unadjusted all-cause revision incidence at 5-years in DTI registrants was: 22.7% Veritas®, 21.0% Flex®, 17.4% TiLOOP® and 18.0% no ADM/Mesh. In contrast for TS procedures the revision incidence was 23.5% TiLOOP®, 22.7% Veritas®, 18.7% Flex® and 20.0% no ADM/Mesh. The most common complications associated with revision are malposition, capsular contracture, deep wound infection, seroma and haematoma. Risk adjusted comparisons will be presented at the conference. Conclusion: Preliminary analysis suggests the use of ADM/Mesh in DTI breast reconstruction does not reduce the incidence of revision, although this is often the justification for their use. This should reinforce the importance of judicious decision-making regarding use of ADM/Mesh in breast reconstructive surgery with implants.