Outcomes after Wise-Pattern Mastectomy with the Inferior Dermal Flap in the Prepectoral Setting: A Systematic Review...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncologic Surgery

Background:

• Wise-pattern incisions are common for mastectomy in patients with macromastia or ptosis.
• These incisions increase the risk of ischemic complications.
• Inferior dermal flaps (autoderm) offer vascularized implant coverage, avoiding acellular dermal matrix (ADM).

Purpose of the Study:

• To evaluate the safety and efficacy of Wise-pattern prepectoral reconstruction using dermal flaps.
• To assess complication rates, including implant loss, infection, and flap necrosis.
• To compare outcomes with ADM-assisted reconstruction and other incision types.

Main Methods:

• Systematic literature search (PubMed, Embase, Cochrane) following PRISMA guidelines.
• Inclusion of studies on Wise-pattern mastectomy with prepectoral dermal flap reconstruction.
• Meta-analysis of pooled data from 10 studies (287 patients, 464 breasts) to estimate complication rates.

Main Results:

• Pooled implant loss rate: 4.8%.
• Pooled infection rate: 7.5%.
• Pooled major mastectomy skin flap necrosis rate: 8.6%.
• Outcomes comparable to ADM reconstruction; higher necrosis with Wise-pattern vs. elliptical incisions.

Conclusions:

• Wise-pattern prepectoral dermal flap reconstruction has low implant loss and infection rates.
• Ischemic complications, particularly flap necrosis, are the most frequent adverse events.
• This technique may expand reconstructive options for specific patient populations, pending higher-quality prospective data.