Wise Pattern versus Transverse Pattern Mastectomy in Two-Stage Implant-Based Breast Reconstruction: A Propensity Score–Matched Analysis

Author:

Escandón Joseph M.1,Butterfield James A.1,Christiano Jose G.1,Gooch Jessica C.2,Olzinski Ann Therese2,Prieto Peter A.2,Skinner Kristin A.2,Langstein Howard N.1,Manrique Oscar J.1

Affiliation:

1. Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center

2. Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center.

Abstract

Background: The Wise pattern adapted to mastectomy incisions has become a valuable asset for breast reconstruction in patients with large and ptotic breasts. The authors compared the time for exchange, time to initiate postmastectomy radiotherapy, and complication rates between Wise pattern and transverse incision pattern reconstructions. Methods: Records of patients who underwent immediate, two-stage, implant-based breast reconstruction (IBBR) between January of 2011 and December of 2020 were retrospectively reviewed. Two cohorts were compared according to the incision pattern: Wise pattern versus transverse incision pattern. Complications were compared after propensity score matching. Results: The authors initially analyzed 393 two-stage immediate IBBRs in 239 patients [91 IBBRs (23.2%) in the Wise pattern group and 302 (76.8%) in the transverse pattern group]. Expansion time (53 days versus 50 days, P = 0.9), time for tissue expander-to-implant exchange (154 versus 175 days, P = 0.547), and time to initiate postmastectomy radiotherapy (144 days versus 126 days, P = 0.616) were not different between groups. Before propensity score matching, the 30-day rate of wound-related complications (32% versus 10%, P < 0.001) and the 30-day rate of wound complications requiring excision/débridement and closure procedures (20% versus 7%, P < 0.001) were significantly higher in the Wise pattern group. After propensity score matching, the 30-day rate of wound complications was persistently higher (25% versus 10%, P = 0.03) in the Wise pattern group. Conclusions: The Wise pattern mastectomy independently increases the incidence of wound-related complications versus only transverse patterns during two-stage IBBR, even after propensity score matching. Delayed tissue expander placement may improve the safety profile of this procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Current Outcomes in Breast Reconstruction;Plastic & Reconstructive Surgery;2023-09-28

2. Sentinel lymph node biopsy and immediate two-stage implant-based breast reconstruction: A propensity score-matched analysis;Journal of Plastic, Reconstructive & Aesthetic Surgery;2023-09

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