OBJECTIVES:  Pre-pectoral breast reconstruction is a less invasive technique compared to dual plane technique and shows promise in improving patient outcomes. This study compares hospital length of stay (LOS) and post-operative outcomes of pre-pectoral (PP) and dual plane (DP) techniques of breast reconstruction. METHODS:  This single-site, retrospective cohort study included data from breast reconstruction procedures from June 2013 to March 2016. Data collected included demographics, chemotherapy/radiation exposure, surgical technique, LOS, drain usage, post-operative incision care and 90 day post-operative complications. Two-sided T-test and Chi-square or Fisher’s Exact tests were performed at α = 0.05. RESULTS: The study included data on 176 patients (DP=117, PP=59) and 335 breasts (DP=225, PP=110). The PP group had a higher BMI (29.5 vs. 26.3 kg/m2; p=0.0017), and a significantly higher proportion of patients with diabetes (13.6% vs. 2.6%; p=0.0073), hypertension (35.6% vs. 17.1%; p=0.0061), and prior breast surgery (36.8% vs. 22.2%; p=0.0415). A higher proportion of PP patients received ciNPT (57.6% vs. 25.6%; p<0.0001) compared to the DP group. There were no differences in complication rates between the two groups. The PP group had a significantly lower LOS compared to DP (mean: 1.1 vs. 1.8 days, p<0.0001). Nearly 95% of PP patients were discharged after 1 hospital day compared to only 25.6% of the DP patients (p<0.0001). Results of multiple regression models were similar to the univariate analyses after controlling for effects of age, BMI, ciNPT use, diabetes, hypertension and prior breast surgery. CONCLUSIONS: This study demonstrated a significantly lower hospital LOS in the PP group compared to DP technique. Complication rates were similar between the two groups even though the PP group was more complex. Studies with a long-term follow up will be critical in understanding the true differences between surgical technique and clinical outcomes.