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. 2025 Mar 14;13(3):e6584.
doi: 10.1097/GOX.0000000000006584. eCollection 2025 Mar.

Wise Versus Vertical Mastopexy Pattern Skin-reducing Mastectomy With Immediate Breast Reconstruction: Systematic Review and Meta-analysis

Sxe Chang Cheong  1   2 , John Maliekkal  1   2 , Wei Shao Tung  1   2 , Ahmad Saadya  2   3 , Guirgis Arsanois Awad  1   2   3
Affiliations

Wise Versus Vertical Mastopexy Pattern Skin-reducing Mastectomy With Immediate Breast Reconstruction: Systematic Review and Meta-analysis

Sxe Chang Cheong et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: This study compares postoperative outcomes of Wise and vertical mastopexy pattern skin-reducing/skin-sparing masctomy, hypothesizing that incision choice affects cosmetic outcomes and complication rates.

Methods: A systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, MEDLINE, Embase, Web of Science, and StarPlus Library. Included studies documented skin-sparing mastectomy using Wise or vertical mastopexy patterns with immediate reconstruction. The primary outcome is total mastectomy flap necrosis. The secondary outcomes are major/minor necrosis, infection, hematoma, seroma, and wound complications. Bayesian and frequentist generalized linear mixed models were used for the meta-analysis, including studies with 0 events.

Results: Sixty-six studies were identified, with 39 included in the meta-analysis, comprising 1954 patients and 2311 breast reconstruction cases. The Wise group had a higher rate of mastectomy flap necrosis (14.2%; 95% confidence interval: 10%-20%; I² = 83%) compared with the vertical group (7.8%; 95% confidence interval: 5%-12%; I² = 0%) (P < 0.05). No significant differences were found in other domains. Subgroup analysis favored vertical mastopexy for wound-related complications (P = 0.04).

Conclusions: The Wise pattern shows significantly higher mastectomy flap necrosis than the vertical pattern. However, there were no significant differences in major necrosis, minor necrosis, infection, hematoma, or seroma. Future studies should focus on larger, high-quality randomized controlled trials to better understand the impact of incision techniques on postoperative outcomes.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article. This study was funded by the University of Sheffield Open Access Fund. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising.

Figures

Fig. 1.
Fig. 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Fig. 2.
Fig. 2.
Outcomes of overall mastectomy flap necrosis for vertical group vs Wise group. *Comparative studies with 2 arms (vertical and Wise). $First-stage IBR only (direct to implant).
Fig. 3.
Fig. 3.
Outcomes of major necrosis for vertical group vs Wise group. *Comparative studies with 2 arms (vertical and Wise). $First-stage IBR only (direct to implant).
Fig. 4.
Fig. 4.
Outcomes of minor necrosis for vertical vs Wise group. *Comparative studies with 2 arms (vertical and Wise). $First-stage IBR only (direct to implant).
Fig. 5.
Fig. 5.
Outcomes for hematoma and seroma for vertical vs Wise group. *Comparative studies with 2 arms (vertical and Wise).
Fig. 6.
Fig. 6.
Outcomes for implant loss and removal for vertical vs Wise group. $First-stage IBR only (direct to implant).
Fig. 7.
Fig. 7.
Outcomes relating to cases of infection for vertical vs Wise group. *Comparative studies with 2 arms (vertical and Wise). $First-stage IBR only (direct to implant).
Fig. 8.
Fig. 8.
Outcomes relating to flap ischemic rate for prosthesis vs autologous in vertical vs Wise group. *Comparative studies with 2 arms (vertical and Wise). $First-stage IBR only (direct to implant).
Fig. 9.
Fig. 9.
Outcomes relating to cases of wound-related complications for vertical vs Wise group. *Comparative studies with 2 arms (vertical and Wise). $First-stage IBR only (direct to implant).
Fig. 10.
Fig. 10.
BREAST-Q outcomes by domain: (A) BREAST-Q psychosocial domain. B, BREAST-Q sexual well-being domain. C, BREAST-Q satisfaction with breast domain. D, BREAST-Q physical well-being domain.
Fig. 11.
Fig. 11.
Funnel plot for studies used in meta-analysis.
See this image and copyright information in PMC

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