Dual-Plane Prosthetic Reconstruction Using the Modified Wise Pattern Mastectomy and Fasciocutaneous Flap in Women with Macromastia

Background: Skin-sparing mastectomy and immediate breast reconstruction in women with macromastia is often difficult. The Wise pattern skin-reducing mastectomy often provides the best options for shape and symmetry, but is not without morbidity. The authors reviewed their experience with a modified Wise pattern mastectomy and tissue expander reconstruction to improve safety. Methods: All patients with breast cancer who underwent a skin-sparing mastectomy and modified Wise pattern skin-reducing reconstruction with a tissue expander were included. A dual-plane technique was used by covering the expander with the pectoralis muscle and a vascularized lower pole fasciocutaneous flap. Patient demographics were queried and outcomes were assessed. Results: Twenty-seven patients (34 breasts) underwent tissue expander reconstruction using the dual-plane vascularized coverage technique. The average body mass index was 34 (range, 24 to 42). The average contralateral reduction weight was 502 g on all 20 unilateral reconstructions. Postoperative complications occurred in 37 percent of the patients (10 of 27), with seroma being the most common [six of 34 reconstructions (18 percent)]. The unplanned reoperation rate was 15 percent. The average follow-up was 16 months (range, 2 months to 4.5 years). Conclusions: The authors have demonstrated that modifications to the Wise pattern mastectomy with a tissue expander using a dual plane of vascularized tissue coverage can optimize results in patients with breast cancer and macromastia. Complications still occur, but they can usually be treated conservatively. (Plast. Reconstr. Surg. 126: 731, 2010.)