title: Analysis of the vertical mammaplasty design in skin-sparing mastectomy and immediate autologous reconstruction.
abstract: BACKGROUND
  Skin-sparing mastectomy designs for immediate autologous breast reconstruction include racquet, Wise, and vertical mammaplasty incisions. The vertical design addresses ptosis while maintaining viable skin flaps. This study compares the racquet to the vertical incision.
  
  
  METHODS
  Immediate skin-sparing autologous breast reconstructions by a single surgeon using either vertical or racquet incisions from August 2006 to September 2011 were analyzed. Aesthetic scoring was based on a Likert-scale assessment of scar appearance, shape, preoperative versus postoperative aesthetic comparison, and overall aesthetic outcome. Responses were analyzed using the Mann-Whitney test.
  
  
  RESULTS
  Seventy-seven patients (48 racquets and 29 vertical) were included. Patient demographics and complications did not differ. Vertical design reconstructions were used for patients with higher-grade ptosis (p < 0.001). Significantly better-appearing scars (3.8 vs. 3.5; p = 0.04) were observed in the vertical group. Vertical reconstructions showed a trend toward significance in cosmetic improvement compared with preoperative appearance (3.2 vs. 3.0; p = 0.06). There was no difference in shape (vertical 3.6, racquet 3.6; p = 0.86) or in postoperative aesthetic result (vertical 3.6, racquet 3.4; p = 0.41).
  
  
  CONCLUSIONS
  Shape and overall postoperative aesthetic appearance did not significantly differ despite greater ptosis preoperatively in the vertical group, demonstrating the efficacy of the vertical design in reconstruction. Vertical design reconstructions were rated aesthetically superior to their pre-mastectomy appearance. Significantly better scar scores in the vertical group reflect the camouflaged nature of vertical incisions. These results demonstrate that the aesthetic outcome of the vertical design reconstruction in ptotic breasts is as good as and potentially superior to the racquet design reconstruction in non-ptotic breasts.
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Bourne
authors.affiliation: Plastic Surgery Arts of New Jersey, New Brunswick, NJ, USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Ahuja
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: gimbelml@upmc.edu.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Gimbel
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Autologous breast reconstruction; Ptosis; Skin-sparing mastectomy; Vertical mammaplasty