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Analysis of the Vertical Mammaplasty Design in Skin-Sparing Mastectomy and Immediate Autologous Reconstruction
Debra A Smith, MD, Naveen Ahuja, MD, Michael L Gimbel, MD
University of Pittsburgh Medical Center Department of Plastic Surgery
2013-03-13
Presenter: Debra A Smith
Affidavit:
All of the work represented in this abstract is original work of the resident and contributing authors. This work has been presented at the Ivy Society Meeting and will be presented at the Plastic Surgery Research Council Meeting.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Skin-sparing mastectomy designs for immediate autologous reconstruction include Wise, racquet, and vertical mammaplasty incisions. In ptotic breasts, racquet incisions do not address ptosis and Wise-patterns have high mastectomy flap necrosis risk. The vertical design addresses ptosis while maintaining viable skin flaps. This study compares the racquet and vertical designs.
Skin-sparing autologous breast reconstructions by a single surgeon from 08/2006 to 09/2011 were analyzed. Aesthetic scoring was based on a Likert-scale assessment of scar appearance, shape, preoperative versus postoperative aesthetic comparison, and overall aesthetic outcome by evaluators unaware of operative technique. Responses were analyzed using the Mann-Whitney Test.
77 patients (48 racquet, 29 vertical) were included. Vertical designs were used for breasts with higher grade ptosis (p=0.0006). Patient demographics and complications did not differ. Vertical design reconstructions had significantly better appearing scars (3.76 vs 3.50; p=0.04). Vertical design reconstructions showed a trend toward significance in cosmetic improvement compared to preoperative appearance (3.20 vs 3.00; p=0.06). There was no difference in shape (vertical 3.55, racquet 3.56; p=0.86) or postoperative aesthetic result (vertical 3.55, racquet 3.40; p=0.41).
Shape and postoperative aesthetic appearance did not differ despite greater ptosis preoperatively in the vertical group, suggesting that the vertical approach is as effective as the racquet design. The vertical design reconstructed breasts were rated aesthetically superior to pre-mastectomy appearance, a reconstructive triumph. Significantly better scar scores in the vertical group reflect their camouflaged nature. The vertical reconstruction of ptotic breasts is equal to superior to the racquet reconstruction of non-ptotic breasts.
