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The "Wiser" Oncoplastic Reduction Mammaplasty – An Approach to Challenging Medial Defects
Xiao Zhu, Francesco M. Egro, Carolyn De La Cruz
University of Pittsburgh Medical Center
2018-01-28
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 information presented in this abstract represents the original work of the presenting medical student and the co-author resident.
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Superficial medial breast tumors pose a significant challenge to oncoplastic reduction mammaplasty because the medial skin flap of the Wise pattern may need to be resected. We describe a modification – the "Wiser" oncoplastic reduction mammaplasty technique - that addresses both skin and parenchymal lumpectomy defects in the upper medial quadrant.
Methods: 68-year-old female with right breast cancer underwent a lumpectomy, requiring unplanned resection of the overlying skin that was part of the Wise pattern medial skin flap. To reconstruct the breast, the medial horizontal limb was extended superiorly to include resected skin overlying the tumor. The "Wiser" pattern medially-based dermoglandular pedicle was created by preserving skin and parenchyma above the IMF, proportional to the excess resected superomedial skin. 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 remainder of the breast reduction was then performed. The tip of the pedicle was sutured to sternal periosteum, and the skin sutured closed.
Discussion: This case report describes a unique modification to the Wise pattern, but not only does it address the skin defect like in other published techniques, but also carries a unique dermoglandular pedicle into the parenchymal defect to autoaugment the breast and provide medial fullness.
Conclusion: The "Wiser" oncoplastic reduction technique allows for skin to be resected en bloc with superficial superomedial tumors, while providing medial breast volume replacement with oncologic safety and good aesthetic results.
