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Management of the Ptotic or Hypertrophic Breast in Immediate Autologous Breast Reconstruction: A Comparison Between the Wise and Vertical Reduction Patterns for Mastectomy

Lin, Ines C. MD*; Bergey, Meredith MSc, MPH; Sonnad, Seema S. PhD; Serletti, Joseph M. MD*; Wu, Liza C. MD*

doi: 10.1097/SAP.0b013e31823b9a41
Breast Surgery

Background The Wise pattern can be used in mastectomies to address the excess skin in the ptotic or hypertrophic breast; however, limitations include mastectomy flap necrosis (MFN) and poor shape. The vertical pattern can potentially reduce the amount of MFN with improved aesthetic results. This study compares the Wise and vertical mastectomy patterns in immediate, autologous breast reconstruction.

Methods Thirty-three patients with grade 2 or 3 ptosis who elected to undergo immediate, autologous breast reconstruction were prospectively recruited into 2 nonrandomized cohorts. Of total, 17 patients (26 reconstructions) had Wise pattern and 16 (28 reconstructions) had vertical pattern. All patients were followed for MFN, time for wound healing, and postoperative complications. Patient and surgeon surveys rated the aesthetics of the reconstructions.

Results The 2 groups did not differ in age, body mass index, smoking, or breast measurements. The Wise group had significantly larger areas of MFN, higher number of postoperative visits, and longer wound-healing periods, compared with the vertical group (P < 0.05). There was no difference in time to adjuvant therapy or additional procedures. Patient surveys rated both incisions with equal satisfaction, except for symmetry that rated better in the Wise group. Surgeon surveys showed better scores for the vertical incision.

Conclusions The Wise pattern is associated with significantly more MFN and prolonged wound care. Despite this complication, patients rate their breast reconstructions favorably, regardless of the type of incision. Both the Wise and vertical patterns can be safely used in skin-sparing mastectomies with immediate, autologous breast reconstruction with good aesthetic outcomes. The authors recommend the vertical pattern because of less MFN and surgeon-preferred aesthetics.

From the *Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA; and †Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.

Received June 20, 2011, and accepted for publication, after revision, October 4, 2011.

Presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, Rancho Mirage, CA, March 23–24, 2009.

Conflicts of interest and sources of funding: This research was supported by a grant from the Edwin and Fannie Gray Hall Center for Human Appearance at the University of Pennsylvania. The authors have no conflicts of interest to declare.

Reprints: Liza C. Wu, MD, Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 10 Penn Tower, Philadelphia, PA 19104. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.