title: Wise-pattern breast reconstruction: modification using AlloDerm and a vascularized dermal-subcutaneous pedicle.
abstract: Immediate implant-based breast mound reconstruction offers many advantages over staged implant reconstruction techniques. For large volume breast reconstruction, a Wise-pattern skin resection may provide very good aesthetic results; however, the submuscular implant pocket is inadequate to cover the inferior pole of the breast. In this patient population, the risk of implant exposure from T-point breakdown is significant. We present our technique of Wise-pattern breast reconstruction using AlloDerm (LifeCell, Branchburg, NJ) and a vascularized dermal-subcutaneous pedicle (DSP) to augment the volume and quality of immediate breast implant coverage, particularly in the area of the T-point suture lines. We reviewed a series of 20 consecutive patients with large breasts who were treated with an immediate implant reconstruction of greater than 400 mL volume using the Wise-pattern with DSP. Preoperative and postoperative 3-dimensional surface scan studies were performed to evaluate breast symmetry. The average volume of breast reconstruction in this study group was 458 mL. T-point breakdown occurred in 5 patients (25%). These patients were treated with local wound care and healed with an excellent aesthetic result. None of these patients required implant removal, implant exchange, or operative debridement. Pre- and postoperative 3-dimensional surface scan analysis of these patients demonstrated comparable differences between the affected and unaffected sides in women undergoing immediate breast implant reconstruction when compared with a matched group of patients undergoing 2-stage breast reconstruction with tissue expanders. Wise-pattern skin-reducing mastectomy is an excellent strategy to provide an aesthetically pleasing, immediate implant breast reconstruction. This technique provides breast symmetry that is at least comparable to that of tissue expander-based, staged implant reconstructions. The reliability of the Wise-pattern technique is significantly improved with the addition of AlloDerm to the muscular pocket and a vascularized DSP to preserve the integrity of the reconstruction in the presence of T-point breakdown.
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Derderian
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
mesh_terms: D000328:Adult; D001940:Breast / Q000033:anatomy & histology / Q000601:surgery*; D019928:Breast Implantation / Q000379:methods; D003094:Collagen / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D009929:Organ Size; D012189:Retrospective Studies; D017768:Skin, Artificial
chemical_list: C440568:Alloderm; D003094:Collagen