Wise-pattern Split-reduction Incision to Facilitate Mastectomy and Direct-to-Implant Reconstruction for Superficial Breast Cancers

Abstract

Summary: The split reduction allows for oncoplastic breast conserving surgery using a modified Wise-pattern closure in ptotic patients with cancers in close proximity to a skin margin. Although cancers involving skin within the Wise pattern are conveniently resected during closure, cancers in close proximity to skin outside the Wise pattern require a modified closure. This modified Wise-pattern closure preserves skin near the inferior pole of the breast which is normally resected and shifts this resection superiorly over the cancer. This also shifts the final medial or lateral inframammary scar onto the visible breast mound. Although this split-reduction Wise pattern has been well described for resecting advanced cancers in patients who undergo oncoplastic breast conserving surgery, this approach has not been described in patients who require mastectomy. Here, we report on 10 consecutive patients with ptosis and advanced breast cancers that require skin resection outside the standard Wise pattern, where we used the split-reduction incision to facilitate mastectomy and direct-to-implant reconstruction.