Reconstruction of the Ptotic Breast Using Wise Pattern Skin Deepithelialization

Abstract

Reconstruction of ptotic or large breasts is challenging due to skin redundancy after skin-sparing mastectomy. Skin reduction can be performed with a long horizontal ellipse, but this often flattens the breast and leaves conspicuous scars medially on the chest. Wise pattern skin reduction is an effective technique for shaping, but excision of skin within the Wise pattern can lead to high rates of skin necrosis and implant exposure or infection. This study describes a technique where the Wise pattern skin is preserved, but deepithelialized, allowing apparent reduction of the skin with preservation of the subdermal plexus. This study reviews data for case series of 26 breasts in 15 patients who have undergone this technique with simultaneous prosthetic reconstruction using an expander.

Fig. 1.

Preoperative view of a patient with grade III breast ptosis. Wise pattern markings have been drawn, as they would be for a standard breast reduction.

Fig. 2.

Same patient as in Figure 1. Bilateral skin-sparing mastectomies were performed through circumareolar incisions. Expanders were placed under the pectoralis major and acellular dermal graft. The expanders were filled to full capacity. The right breast skin has been tailor tacked with staples along the Wise pattern skin markings to assess for skin redundancy.

Fig. 3.

Same patient as in Figure 1. The staples have been removed and the skin within the Wise pattern markings has been deepithelialized bilaterally. The acelluar dermal allograft and a small portion of the pectoralis major muscle can be seen through the circular mastectomy incisions.

Fig. 4.

Postoperative view of the same patient after the expanders have been replaced with implants, but before nipple reconstruction.