title: A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction.
abstract: BACKGROUND
  Patients with large or ptotic breasts undergoing mastectomy followed by tissue expander/implant-based reconstruction may benefit from a Wise (inverted-T) pattern reduction mammaplasty incision compared with the traditional horizontal elliptical incision. The authors compared these two groups of patients with regard to complication rates and outcomes.
  
  
  METHODS
  Sixty-nine patients (117 breasts) were identified who underwent Wise pattern mastectomy and two-stage reconstruction. A control group of 89 patients (136 breasts) who underwent reconstruction after horizontal elliptical mastectomy were selected over the same period. Patient demographics, clinical characteristics, and complication rates were recorded and analyzed statistically.
  
  
  RESULTS
  Patient demographics (age, body mass index, diabetes, smoking, and irradiation history) and clinical characteristics (laterality, expander size and fill volume, and time to expansion) were similar, with the exception of body mass index (control, 26.7 kg/m; inverted-T, 28.7 kg/m; p = 0.04) and mean intraoperative fill volume (control, 158.7 cc; inverted-T, 196.9 cc; p = 0.02). Of all complications (infection, seroma, flap necrosis, expander loss, and salvage), only the rate of mastectomy flap necrosis was significantly greater (p = 0.002) in patients undergoing inverted-T mastectomy (25.6 percent versus 11.0 percent). This difference did not result in a significantly higher rate of expander loss or need for salvage surgery.
  
  
  CONCLUSIONS
  The inverted-T mastectomy approach can be performed safely with acceptable complication rates. When compared with an internal control group, complication rates were similar, with the exception of mastectomy flap necrosis. Despite a higher rate of flap necrosis, 91 percent of inverted-T patients successfully completed the expansion process.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: East Meadow and Garden City, N.Y. From the Nassau University Medical Center and the Long Island Plastic Surgical Group.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Kilgo
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Kaufman
authors.forename: Allison E
authors.initials: AE
authors.lastname: Shen
authors.forename: Jessica
authors.initials: J
authors.lastname: Korsh
authors.forename: Nadia V
authors.initials: NV
authors.lastname: Baranchuk
authors.forename: Barry K
authors.initials: BK
authors.lastname: Douglas
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Brewer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods; D015625:Tissue Expansion Devices; D016896:Treatment Outcome