Grisotti versus Wise-Pattern Oncoplastic Reconstruction in Central Breast Cancer: A Randomized Controlled Study

Central breast tumors requiring excision of the nipple-areola complex present a reconstructive challenge in breast-conserving surgery. Volume-displacement oncoplastic techniques, including the Grisotti flap and reduction-based Wise-pattern reconstruction, allow breast preservation while maintaining oncological safety. This study compares the short-term oncological and aesthetic outcomes of these two techniques.

A randomized controlled trial was conducted, enrolling 40 patients with centrally located breast cancer who underwent breast-conserving surgery between March 2023 and November 2024. Patients were randomized to reconstruction using either the Grisotti technique (n = 20) or the Wise-pattern technique (n = 20). The primary outcome was surgical margin status. Secondary outcomes included postoperative complications and aesthetic satisfaction. The mean follow-up duration was 6.9 months.

Mean tumor size was 3.2±1.5 cm in the Grisotti group and 2.6±0.8 cm in the Wise-pattern group (p = 0.327). The mean tumor-to-nipple-areola complex distance was 2.17±1.01 cm in the Grisotti group and 2.90±1.04 cm in the Wise-pattern group (p = 0.428). Negative surgical margins were achieved in 90% and 100% of cases, respectively (p = 0.487), with re-excision required in two Grisotti cases. Postoperative complications did not differ significantly between groups; seroma was the most frequent complication (25% vs. 20%, p = 1.0). Patient satisfaction was rated as good or excellent in 85% of Grisotti cases and 90% of Wise-pattern cases (p = 0.549). Mean surgeon satisfaction scores were 7.55±1.39 and 8.10±0.72, respectively (p = 0.128). No cases of flap necrosis were observed.

Both the Grisotti and Wise-pattern techniques demonstrated comparable short-term oncological safety and satisfactory aesthetic outcomes in breast-conserving surgery for central breast tumors. Differences in patient and surgeon satisfaction did not reach statistical significance. The Grisotti technique is most suitable for patients with small-to-moderate breast volumes and mild-to-moderate ptosis, while the Wise-pattern technique offers advantages in macromastia, significant ptosis, or when contralateral symmetrisation is planned. These findings support individualized technique selection based on breast volume and anatomical considerations, while highlighting the need for larger studies with longer follow-up to assess long-term oncological and aesthetic outcomes, and prospective use of validated aesthetic outcome instruments.