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Implant Reconstruction in the Ptotic Patient: Evaluation of Wise and Vertical Skin Sparing Mastectomy
Mary M. Holohan, MS; Stephanie M. Diaz, MS; Keeley Newsom, MS; Alex Smith, MD; Nikhi Singh, MD; Betty Fan, DO; Folsade O. Imeokparia, Carla S. Fisher, MD; Kandice K. Ludwig, MD; Mary E. Lester, MD; Aladdin H. Hassanein, MD
IU School of Medicine
2023-02-10
Presenter: Mary M. Holohan or Stephanie M. Diaz
Affidavit:
Mary M. Holohan, MS; Stephanie M. Diaz, MS; Keeley Newsom, MS; Alex Smith, MD; Nikhi Singh, MD; Betty Fan, DO; Folsade O. Imeokparia, Carla S. Fisher, MD; Kandice K. Ludwig, MD; Mary E. Lester, MD; Aladdin H. Hassanein, MD; William Wooden, MD
Director Name: William Wooden, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
Patients with severe breast ptosis who undergo mastectomy can pose a reconstructive challenge. Traditionally, a skin sparing mastectomy (SSM) with a circumareolar incision results in a long, horizontally oriented scar in the central breast. The Wise pattern skin sparing mastectomy (SSM) with an inferiorly based dermal flap has been described but wound healing complications at the T-point can be problematic. The vertical pattern SSM with a medially-based dermal flap under the incision avoids the T-point. The purpose of this study was to compare outcomes of the Wise pattern and modified vertical pattern SSM in implant-based reconstruction.
Methods:
Patients that underwent SSM using a Wise or vertical skin reducing technique were reviewed. Predictive variables and clinical outcomes were assessed.
Results:
SSM was performed in 42 patients using either the Wise (n= 49 breasts, 31 patients) or vertical (n= 18 breasts, 11 patients). Both groups had similar BMI (35.43). The prepectoral plane was used in 93.5% of Wise pattern patients and all vertical patients. All cases of seroma and hematoma occurred in the Wise pattern group (10.2%). Mastectomy skin necrosis requiring debridement occurred in 20.4% of those undergoing Wise pattern SSM and 11.1% in the vertical group (p=0.49).
Conclusion:
Severely ptotic patients undergoing skin sparing mastectomy have a high risk of complications, particularly skin necrosis. A dermal flap under the closure has the advantage of vascularized tissue reinforcing the wound in prepectoral reconstruction. The vertical pattern using a medially based dermal flap is a safe, simpler alternative to the Wise pattern.
