Holohan M Margaret, Diaz Stephanie M, Newsom Keeley, Smith Alex, Fan Betty, Imeokparia Folasade O, Fisher Carla S, Ludwig Kandice K, Lester Mary E, Hassanein Aladdin H
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Surgical Oncology, Indiana University School of Medicine, Indianapois, IN, USA.
Plast Surg (Oakv). 2024 Mar 12:22925503241234940. doi: 10.1177/22925503241234940.
Post-mastectomy reconstruction in patients with severe breast ptosis can be challenging. Traditionally, a skin sparing mastectomy (SSM) with a circumareolar incision or a horizontal elliptical extension results in a long, horizontally-oriented scar in the central breast. The Wise pattern SSM with an inferiorly-based dermal flap addresses skin redundancy and provides added vascularized implant coverage in ptotic patients with macromastia. The purpose of this study is to compare outcomes in ptotic patients undergoing SSM with Wise pattern and a modified vertical technique which also uses de-epithelialized excess skin under the incision. A retrospective chart review was performed on patients that underwent SSM using a Wise or vertical skin reducing technique. The Wise pattern was performed using an inferiorly-based dermal flap and the vertical method used a laterally-based dermal flap covering the implant/tissue expander (TE). SSM with the use of autoderm was performed in 42 patients (67 breasts) using either the Wise (n = 49 breasts) or vertical (n = 18 breasts) method. Both groups had similar BMI (35.4). The prepectoral plane was used in 93.5% of Wise pattern patients and all vertical patients. All cases of seroma and hematoma occurred in the Wise pattern group (10.2%). Mastectomy skin necrosis requiring unplanned return to surgery for debridement occurred in 20.4% of those undergoing Wise pattern SSM and 11.1% undergoing the vertical pattern (p = 0.49). Severely ptotic patients undergoing SSM have a high risk of skin necrosis. A dermal flap under the closure has the advantage of vascularized tissue reinforcing the wound in implant based reconstruction. The vertical pattern SSM using a laterally-based dermal flap may be a safe, simple alternative to the Wise pattern in select patients.
对于重度乳房下垂患者，乳房切除术后重建颇具挑战性。传统上，采用乳晕周围切口或水平椭圆形延长切口的保乳皮肤乳房切除术（SSM）会在乳房中央留下一条长的水平方向疤痕。采用下方带蒂真皮瓣的Wise模式SSM可解决皮肤冗余问题，并为巨乳症伴乳房下垂患者提供额外的带血管蒂植入物覆盖。本研究的目的是比较采用Wise模式和改良垂直技术（该技术也使用切口下方去上皮化的多余皮肤）进行SSM的乳房下垂患者的手术效果。对采用Wise或垂直皮肤缩减技术进行SSM的患者进行了回顾性病历审查。Wise模式采用下方带蒂真皮瓣，垂直法采用外侧带蒂真皮瓣覆盖植入物/组织扩张器（TE）。42例患者（67侧乳房）采用自体真皮进行SSM，其中采用Wise法（n = 49侧乳房）或垂直法（n = 18侧乳房）。两组患者的体重指数（BMI）相似（35.4）。93.5%的Wise模式患者和所有垂直法患者采用胸肌前平面。所有血清肿和血肿病例均发生在Wise模式组（10.2%）。需要计划外返回手术进行清创的乳房切除皮肤坏死发生率在接受Wise模式SSM的患者中为20.4%，在接受垂直模式的患者中为11.1%（p = 0.49）。接受SSM的重度乳房下垂患者有较高的皮肤坏死风险。闭合切口下方的真皮瓣具有带血管组织加强植入物重建伤口的优势。对于部分患者，采用外侧带蒂真皮瓣的垂直模式SSM可能是Wise模式安全、简单的替代方法。
