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The "Wiser" Oncoplastic Reduction Mammaplasty – An Approach to Challenging Medial Defects
Xiao Zhu, Francesco M. Egro, Carolyn De La Cruz
UPMC
2019-02-13
Presenter: Xiao Zhu
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Superficial medial breast tumors pose a challenge to oncoplastic reduction mammaplasty as they may necessitate skin resection that would have otherwise formed the medial skin flap of the standard Wise pattern. We describe a modification – the "Wiser" oncoplastic reduction technique - that addresses both skin and parenchymal lumpectomy defects in the upper medial quadrant.
Methods: Our patient's breast tumor required unplanned resection of the overlying skin, which was part of the Wise pattern medial skin flap. The medial horizontal limb was extended superiorly to include resected skin overlying the tumor. Skin and parenchyma were preserved above the IMF proportional to the excess resected skin to form the new "Wiser" pattern dermoglandular pedicle. The remainder of the breast reduction was then performed. The area on the pedicle lateral to the breast meridian was de-epithelialized, freed from the IMF inferiorly, and folded underneath to fill the medial lumpectomy cavity. The tip of the pedicle was sutured to the sternal periosteum, and skin sutured closed.
Discussion: Others have described similar modifications to the Wise pattern, in which resected superomedial skin flap is replaced by a skin flap above the medial IMF. Here we describe a comparable modification, but not only does it address the skin defect, but also carries a dermoglandular pedicle into the parenchymal defect to autoaugment the breast and provide fullness.
Conclusion: The "Wiser" technique allows for skin to be resected en bloc with superficial medial tumors, while providing medial breast volume replacement with oncologic safety and good aesthetic results.
