Experience with the Wise mammaplasty skin resection pattern in skin-sparing mastectomy and immediate breast reconstruction for large breast volumes

Abstract

Introduction: Skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) remain technically challenging in very large breasted women, often requiring extensive skin reduction, with a high incidence of post-operative complications. We report our retrospective experience (1999-2007) with SSM and Wise pattern skin reduction in IBR, and examine factors contributing to recipient site post-operative complications.

Results: 29 reconstructions comprising 16 free TRAM/DIEPs, 5 pedicled TRAMs, and 8 implant-based ones were undertaken in 25 patients aged 32-70 years (median = 48). Their mean BMI was 30.4 kg/m² (r = 22.3-39.3) and 6/25 were current smokers. There were 14 (48%) associated axillary clearances. All breasts had grade 2 or 3 ptosis. The mastectomies weighed 805 g-1972 g (mean = 1326). Sixteen operations (55%) developed complications; 7 minor, 9 requiring further surgical intervention. Of these 16 cases, 13 involved skin complications and 9 involved culture-proven wound infections. All patients achieved satisfactory aesthetic outcomes. At median cancer follow-up of 24 months (r = 2-98), there have been no local recurrences but two deaths from distant metastases. Mastectomy weight was significantly associated with major skin complications requiring surgery (age-adjusted OR per 100 g = 1.6; CI = 1.1-2.3, p = 0.02). Performance of axillary clearance at the time of skin-sparing mastectomy was significantly associated with risk of post-operative infection (age-adjusted OR = 5.8; CI = 1.3-26.0, p = 0.021). These relationships were maintained after adjusting for patient, surgical and tumour factors.

Conclusion: Wise pattern skin reduction is a useful technique for managing large, ptotic breasts during SSM and IBR. Increasing breast size and the type of cancer surgery are important predictors of post-operative complications.