A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction

Area of Science:

• Plastic Surgery
• Oncology
• Reconstructive Surgery

Background:

• Mastectomy with tissue expander/implant reconstruction is common for large or ptotic breasts.
• The Wise (inverted-T) pattern incision is a potential alternative to the traditional horizontal elliptical incision for mastectomy.
• Comparing complication rates and outcomes between these two incision patterns is crucial for optimizing patient care.

Purpose of the Study:

• To compare the complication rates and outcomes of Wise (inverted-T) pattern mastectomy versus traditional horizontal elliptical mastectomy in patients undergoing two-stage breast reconstruction.
• To evaluate the safety and efficacy of the Wise (inverted-T) pattern incision in the context of breast reconstruction.

Main Methods:

• A retrospective study comparing 69 patients (117 breasts) who underwent Wise pattern mastectomy and reconstruction with 89 patients (136 breasts) who had horizontal elliptical mastectomy.
• Statistical analysis was performed on patient demographics, clinical characteristics, and complication rates, including infection, seroma, flap necrosis, expander loss, and salvage.

Main Results:

• Patient demographics and clinical characteristics were largely similar between the groups, with minor differences in body mass index and intraoperative fill volume.
• The Wise (inverted-T) mastectomy group experienced a significantly higher rate of mastectomy flap necrosis (25.6% vs. 11.0%).
• Despite the increased flap necrosis rate, there was no significant difference in expander loss or the need for salvage surgery between the two groups.

Conclusions:

• The Wise (inverted-T) mastectomy approach is a safe option for breast reconstruction with acceptable complication rates.
• While mastectomy flap necrosis is more frequent with the inverted-T pattern, it does not significantly impede the overall success of the two-stage reconstruction process.
• A high success rate (91%) in completing the expansion process was observed in patients undergoing the inverted-T mastectomy.