Wise Pattern versus Transverse Pattern Mastectomy in Two-Stage Implant-Based Breast Reconstruction: A Propensity...

Breast reconstruction techniques continue to evolve to address patient-specific anatomical challenges. Surgeons often face decisions about incision patterns that influence postoperative outcomes. Prior research has shown that incision design can affect healing and complication rates. However, no prior work had resolved the comparative safety of the Wise pattern versus the transverse pattern in two-stage implant-based breast reconstruction. This gap motivated a detailed evaluation of complication rates and procedural timing. The need for evidence-based guidance on incision selection remains unmet. Surgeons require data on how different incision patterns influence recovery. Understanding these differences can help optimize patient care. This study addresses a critical need in reconstructive surgery practice.

This study aimed to compare wound complication rates and procedural timing between two incision patterns in two-stage implant-based breast reconstruction. The specific problem is the lack of clarity on which incision pattern leads to better outcomes. The authors sought to determine if the Wise pattern incision increases the risk of complications compared to the transverse pattern. They focused on time to initiate radiotherapy and tissue expander exchange. The motivation stems from the need to improve postoperative safety and recovery. Surgeons require evidence to guide incision choices for large or ptotic breasts. This study fills a gap in reconstructive surgery literature. The findings may influence clinical decision-making in breast reconstruction.

The researchers conducted a retrospective review of patient records from 2011 to 2020. They analyzed 393 two-stage implant-based breast reconstructions across 239 patients. Patients were divided into two groups based on incision pattern. The first group used the Wise pattern, and the second used the transverse pattern. Propensity score matching was applied to reduce confounding variables. The study measured time to tissue expander exchange and time to initiate radiotherapy. Wound-related complications were evaluated within 30 days post-surgery. Statistical analysis compared outcomes between the two groups.

The study found no significant difference in expansion time between the two groups. Time to exchange tissue expanders was also similar (154 days versus 175 days, P = 0.547). Time to initiate postmastectomy radiotherapy did not differ significantly (144 days versus 126 days, P = 0.616). Before matching, the Wise pattern group had a 32% 30-day wound complication rate compared to 10% in the transverse group. The rate of wound complications requiring excision or débridement was 20% in the Wise group versus 7% in the transverse group. After propensity score matching, the Wise pattern still had a higher 30-day wound complication rate (25% versus 10%, P = 0.03). The Wise pattern was independently associated with increased wound complications. These findings suggest a higher risk with the Wise pattern incision.

The authors concluded that the Wise pattern incision is independently linked to higher wound complication rates. Their findings suggest that the transverse pattern may offer a safer alternative in two-stage implant-based breast reconstruction. The study supports the use of transverse incisions for patients at higher risk of wound issues. Surgeons should consider this when selecting incision patterns. The results do not suggest that the Wise pattern is unsafe but highlight its higher complication risk. The authors propose that delayed tissue expander placement may reduce complications. This conclusion is based on the observed outcomes in the matched cohorts. The study provides evidence to guide incision selection in reconstructive surgery.