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Staged Wise-Pattern Skin Excision for Reconstruction of the Large and Ptotic Breast

Liu, Tom S. M.D., M.B.A.; Crisera, Christopher A. M.D.; Festekjian, Jaco H. M.D.; Da Lio, Andrew L. M.D.

Plastic and Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - p 1831-1839
doi: 10.1097/PRS.0b013e3181f5278f
Breast: Original Articles

Background: The postmastectomy reconstruction of large and/or ptotic breasts poses a more difficult aesthetic challenge than the reconstruction of small or moderately sized breasts because of an excessively large skin envelope in both horizontal and vertical dimensions. The Wise-pattern skin excision best addresses this excess skin but is associated with a high incidence of tissue necrosis with subsequent wound breakdown, primarily at the T point. To optimize the aesthetic potential and minimize complications in the setting of these large skin envelopes, the authors have deconstructed the single-stage Wise-pattern skin excision into a two-stage procedure, eliminating the need for a primary simultaneous T-point closure.

Methods: In the first stage, the mastectomy and reconstruction are performed using a vertical excision, which tightens the breast skin envelope horizontally. In the second stage, the redundant skin at the inframammary fold is excised horizontally, tightening the breast skin envelope vertically. The summation of the two staged excisions recreates the Wise pattern, breaking up the T point into two straightforward primary closures.

Results: Twelve patients (21 breasts) underwent successful reconstruction using the staged Wise-pattern skin excision. The breast size, shape, and projection of the patients were greatly improved without any wound complications.

Conclusions: The staged Wise-pattern skin excision for breast reconstruction is a simple technique that delivers superior results for the challenging reconstruction of large and/or ptotic breasts. This method offers an aesthetically pleasing breast shape, allows for the correction of ptosis, eliminates wound complications, and results in a standard Wise-pattern scar.

Los Angeles, Calif.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles Medical Center.

Received for publication April 6, 2010; accepted June 17, 2010.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Andrew L. Da Lio, M.D., Division of Plastic and Reconstructive Surgery, University of California, Los Angeles Medical Center, 200 Medical Plaza, Suite 465, Los Angeles, Calif. 90095-6904,

©2010American Society of Plastic Surgeons