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Exploring the Impact of Inverted T Patterns Versus Vertical Incisions on Superomedial Pedicle Breast Reduction Outcomes: Systematic Review and Meta-Analysis.
Osama Darras, MD, PhD(c); Adam Ghazoul, BS; Bryce Pember, BS; Sean Frisbie, BS; Diwakar Phuyal, MBBS; Raffi Gurunian, MD, PhD; Sarah N. Bishop, MD.
Cleveland Clinic
2025-01-09
Presenter: Osama Darras, MD, PhD(c)
Affidavit:
Raymond Isakov, MD
Director Name: Raymond Isakov, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE:
Superomedial pedicle breast reduction with inverted T or vertical skin resection has gained popularity. This review examines how different skin resection types may affect the outcomes of these surgeries.
METHODS:
We reviewed the MEDLINE and Embase databases for articles on the outcomes of superomedial pedicle breast reduction, adhering to PRISMA guidelines. Key search terms included synonyms for "breast reduction" and "complications." Using SPSS version 29.0, we analyzed outcomes while matching body mass index (BMI), excised tissue mass, and patient age to reduce bias. Complications evaluated included areolar necrosis, infection, wound dehiscence, hypertrophic scarring, altered sensation, seroma, hematoma, fat necrosis, dog ear deformities, and delayed healing.
RESULTS:
42 studies that included 9,525 breasts from 4,848 patients. The mean age was 41.9 years, and the mean BMI was 28.7. The mean mass of excised breast tissue was 787.3 grams. Complications were significantly higher with vertical scar closure compared to inverted T pattern closure (17.97% vs 12.79%, p<0.001). Subgroup analysis revealed higher rates of nipple necrosis, infection, wound dehiscence, widened and hypertrophic scars, seroma, hematoma, fat necrosis, , dog ear deformity, and revisions in the vertical scar approach (p<0.001), while altered sensation was more common in the inverted T pattern (p<0.001). Delayed wound healing rates were similar between the groups (p = 0.666).
CONCLUSION:
Vertical skin closure has more complications than the inverted T pattern but results in less altered sensation. Both patients and surgeons should choose the technique based on the patient's goals and anticipated complications.
