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Dual-Plane Prosthetic Reconstruction Using the Modified Wise Pattern Mastectomy and Fasciocutaneous Flap in Women with Macromastia

Losken, Albert M.D.; Collins, Beth A. M.D.; Carlson, Grant W. M.D.

Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 731-738
doi: 10.1097/PRS.0b013e3181e3b38a
Breast: Original Articles

Background: Skin-sparing mastectomy and immediate breast reconstruction in women with macromastia is often difficult. The Wise pattern skin-reducing mastectomy often provides the best options for shape and symmetry, but is not without morbidity. The authors reviewed their experience with a modified Wise pattern mastectomy and tissue expander reconstruction to improve safety.

Methods: All patients with breast cancer who underwent a skin-sparing mastectomy and modified Wise pattern skin-reducing reconstruction with a tissue expander were included. A dual-plane technique was used by covering the expander with the pectoralis muscle and a vascularized lower pole fasciocutaneous flap. Patient demographics were queried and outcomes were assessed.

Results: Twenty-seven patients (34 breasts) underwent tissue expander reconstruction using the dual-plane vascularized coverage technique. The average body mass index was 34 (range, 24 to 42). The average contralateral reduction weight was 502 g on all 20 unilateral reconstructions. Postoperative complications occurred in 37 percent of the patients (10 of 27), with seroma being the most common [six of 34 reconstructions (18 percent)]. The unplanned reoperation rate was 15 percent. The average follow-up was 16 months (range, 2 months to 4.5 years).

Conclusions: The authors have demonstrated that modifications to the Wise pattern mastectomy with a tissue expander using a dual plane of vascularized tissue coverage can optimize results in patients with breast cancer and macromastia. Complications still occur, but they can usually be treated conservatively.

Atlanta, Ga.

From the Emory Division of Plastic and Reconstructive Surgery, Emory University School of Medicine.

Received for publication December 19, 2009; accepted February 17, 2010.

Disclosures: Albert Losken is a consultant for Mentor and a speaker for LifeCell. None of the authors has a financial interest in any of the products or devices mentioned in this article.

Albert Losken, M.D. Emory Division of Plastic and Reconstructive Surgery; 550 Peachtree Street, Suite 84300; Atlanta, Ga. 30308;

©2010American Society of Plastic Surgeons