From the Department of Surgery, San Joachin General Hospital, French Camp, CA.
University of Mississippi School of Medicine, Jackson, MS.
Ann Plast Surg. 2022 Jun 1;88(5 Suppl 5):S498-S500. doi: 10.1097/SAP.0000000000003158.
Breast reduction has a well-chronicled history and remains a common reason for patients to seek plastic surgery consultation. The Wise pattern is the most common skin reduction pattern in the United States. Vertical pattern reduction is also widely used and offers the potential for decreased scar burden. Both patterns have been used with a variety of pedicles for preservation of the nipple areolar complex, which may also impact complication rate and patient satisfaction. There is a preponderance of literature on breast reduction surgery but limited comparative data on the safety profile of these patterns. The purpose of this article is to review the comparative literature, with emphasis on the overall risk of complications.
OVID and PubMed were used to query the literature for articles comparing complication rates in both Wise pattern and vertical breast reduction. Inclusion criteria were case series that encompassed both vertical and Wise pattern reductions and cited the rate of complications. Complications included in our analysis of total complication rate were as follows: hematoma, seroma, infection, dehiscence, fat necrosis, skin necrosis, and nipple areolar complex necrosis. We excluded standing cutaneous deformity as a complication. Articles that included oncoplastic breast reductions were also excluded. The primary analysis was an inverse variance-weighted random-effect meta-analysis of overall complication rate, with the association between the technique and overall complication rate quantified using odds ratios.
Eight articles were identified that met inclusion criteria, representing 963 patients (525 Wise pattern and 438 vertical pattern). The overall complication rate pooled across the studies favored vertical pattern reduction, but the result was not definitive.
Vertical pattern breast reduction can be done safely. Our statistical analysis found a trend toward decreased complications with vertical reductions, but did not reach statistical significance. Patients seeking breast reduction are a heterogeneous population with respect to breast size, degree of ptosis, body habitus, body mass index, comorbidities, and acceptance of scars. It remains important to individualize the approach to the patient and their needs. More quantitative, comparative data, especially from randomized controlled trials, would be useful to further evaluate the relative safety profiles of the 2 patterns.
乳房缩小术有着悠久的历史，仍是患者寻求整形咨询的常见原因。Wise 皮瓣是美国最常见的皮肤切除模式。垂直皮瓣切除术也被广泛应用，并有可能减少疤痕负担。这两种模式都被用于各种皮瓣，以保留乳头乳晕复合体，这也可能影响并发症发生率和患者满意度。乳房缩小术有大量文献，但关于这些模式安全性的比较数据有限。本文旨在回顾比较文献，重点关注总体并发症风险。
我们使用 OVID 和 PubMed 检索文献，比较 Wise 模式和垂直乳房缩小术的并发症发生率。纳入标准为涵盖垂直和 Wise 皮瓣切除术且引用并发症发生率的病例系列。我们分析的总并发症发生率包括以下并发症：血肿、血清肿、感染、裂开、脂肪坏死、皮肤坏死和乳头乳晕复合体坏死。我们将直立性皮肤畸形排除在并发症之外。也排除了包括肿瘤整形乳房缩小术的文章。主要分析是总体并发症发生率的逆方差加权随机效应荟萃分析，使用比值比量化技术与总体并发症发生率之间的关联。
有 8 篇文章符合纳入标准，共 963 例患者（525 例 Wise 皮瓣和 438 例垂直皮瓣）。研究中总体并发症发生率倾向于垂直皮瓣切除术，但结果并不明确。
垂直皮瓣乳房缩小术是安全的。我们的统计分析发现垂直皮瓣切除术的并发症发生率呈下降趋势，但未达到统计学意义。寻求乳房缩小术的患者在乳房大小、下垂程度、体型、体重指数、合并症和对疤痕的接受程度方面存在差异。根据患者及其需求个体化治疗仍然很重要。更多定量的、比较的数据，特别是来自随机对照试验的数据，将有助于进一步评估这两种模式的相对安全性。
