title: Dual-plane prosthetic reconstruction using the modified wise pattern mastectomy and fasciocutaneous flap in women with macromastia.
abstract: 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.
authors.affiliation: Atlanta, Ga. From the Emory Division of Plastic and Reconstructive Surgery, Emory University School of Medicine.
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
authors.forename: Beth A
authors.initials: BA
authors.lastname: Collins
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology* / Q000601:surgery*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D006984:Hypertrophy; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps
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