PURPOSE

Plastic surgeons are often faced with the difficulty of performing breast reconstruction in patients with macromastia and obesity. This population often demonstrates increased complication rates and compromised cosmetic outcomes. We present a technique that provides excellent cosmetic outcomes while offering a single stage reconstruction using a Wise pattern design.

METHOD

During a three year period, 70 patients underwent mastectomies using a Wise pattern design. All patients had a body mass index >25.  All patients presented with macromastia and breast ptosis. The breast reconstruction technique involved the use of an inferior dermal flap in conjunction with medial and lateral acellular dermal matrix patches. A saline implant was used in this single stage reconstruction. Patients were followed for a mean duration of 18 months. Postoperative complications including infection and flap necrosis were recorded.

RESULTS

Four patients (5.7%) developed postoperative infections requiring IV antibiotic treatment. Of these patients, three (4.3%) required removal of the implant.  Two patients (2.8%) developed partial flap necrosis requiring prolonged wound care. Seven patients (10%) experienced minor delayed wound healing with no flap loss.  All patients were satisfied with the results and reported an excellent aesthetic outcome.

CONCLUSION Skin sparing mastectomy utilizing a Wise pattern with an inferior deepithelialized flap and immediate implant reconstruction is a safe and viable option for this population of patients.  The deepithelialized surplus skin provides an autologous tissue lining for the lower implant pocket making elevation of rectus fascia or serratus muscle unnecessary.  This technique produces excellent cosmetic results with low complication rates and fewer operative procedures in breast reconstruction patients with macromastia.