Abstract: Apparatus and methods enable insertion and tensioned deployment of a secondary material prosthetic device into a body cavity or other tissue of a patient, such as for example hernia repair mesh into the abdominopelvic cavity of a patient through the hernia site. The present invention establishes fixation sites for the prosthetic device and tensions it against the body tissue. It may also be used implant fixation devices within the body tissue so that the prosthetic device is tensioned into firm abutting contact with the body tissue. Instrument deployment and fixation struts may be advanced in retrograde fashion in order to reduce needed deployment volume within the patient's body cavity. The prosthetic device advantageously may be flexibly coupled to the instrument via fixation devices such as sutures, so as to increase orientation flexibility.