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The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies.

William B Albright, Patrick J Hawkes

    Aesthetic Surgery Journal. Open Forum
    |April 1, 2021
    PubMed
    Summary

    A novel bell pattern skin excision offers a safe and adaptable technique for immediate implant-based breast reconstruction in patients with large or ptotic breasts, minimizing major complications.

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    Area of Science:

    • Plastic Surgery
    • Breast Reconstruction
    • Surgical Techniques

    Background:

    • Immediate direct to permanent implant-based breast reconstruction (IBBR) is increasingly popular.
    • Surgeons face challenges applying IBBR to patients with large or ptotic breasts.
    • A novel bell pattern skin excision aims to mitigate complications in this population.

    Purpose of the Study:

    • To describe a new bell pattern skin excision for IBBR in patients with large or ptotic breasts.
    • To assess the safety and adaptability of this novel technique.
    • To evaluate its ability to manage intraoperative variations.

    Main Methods:

    • Retrospective analysis of 17 patients (31 breasts) undergoing skin-reducing mastectomy with IBBR using the bell pattern.
    • Inclusion criteria: large or ptotic breasts.
    • Data collected on pre-operative planning, intraoperative adjustments, and post-operative complications.

    Main Results:

    • The bell pattern was planned preoperatively for all breasts.
    • 3 breasts (10%) required alternative closure due to ischemia or oncologic resection.
    • The pattern accommodated flap ischemia in 8 breasts (26%). No major complications or reconstruction failures were observed.
    • Minor complications included seroma (18%) and incision wound issues (11%).

    Conclusions:

    • The bell pattern skin excision is a safe and adaptable alternative for skin-reducing mastectomy in IBBR.
    • It effectively manages challenges associated with large or ptotic breasts.
    • This technique shows promise for reducing major complications in high-risk patients.