Akademik Veri Yönetim Sistemi
ESPRAS Quadrennial Congress 2022, Porto, Portekiz, 5 - 07 Ekim 2022
Reduction Mammaplasty: A Six-Year Retrospective Review
of Wise-Pattern Technique
Introduction
Reduction mammoplasty is one of the most commonly
performed surgical procedures, not only for cosmetic purposes, but also for
increasing the quality of life. Historically, many different techniques,
pedicles have been defined, and the wise-pattern technique, defined by Robert
J. Wise in 1956, is one of the most frequently used techniques because it
allows severe skin and tissue excision. Preoperative breast imaging has gained
importance due to the rapid increase in the number of breast cancer and
aesthetic procedures and the legal problems that physicians may encounter. In
this study, the operation technique, complications, preoperative BI-RADS
evaluation and pathology reports in our patients who underwent reduction
mammoplasty was evaluated.
Materials and Methods
The study was conducted at the Plastic and
Reconstructive Surgery Department of Dokuz Eylul University Hospital. We
conducted a retrospective review of 384 reduction mammoplasties in 192 patients
from 2016 to 2022. In all cases, the wise-pattern technique was performed. Age,
incisura jugularis-nipple, nipple-inframammarian fold distances, smoking,
pedicle, preoperative BI-RADS evaluation, pathology result, excision weight,
complications of patients who underwent reduction mammoplasty on different
pedicles with reverse t scar in wise pattern were included in the study. Patients
who underwent re-reduction mammoplasty and unilateral reduction mammoplasty for
breast reconstruction after mastectomy were not included in the study.
Results
A total of 384 breasts from 192 patients
were evaluated. The mean age of the patients were 42.84. 125 patients were
non-smokers and 8 patients were social smokers. 59 patients were actively
smoking, the average pack year was calculated as 10.1. The mean incisura
jugularis-nipple distance was 30.5, and the nipple-inframammarian fold distance
was 13.5. Reduction mammoplasty with pedicle was performed superomedial in 52
patients, inferior in 47 patients, central superomedial in 38 patients,
superocentral in 14 patients, central in 14 patients, inferocentral in 12
patients, superolateral in 8 patients, superior in 5 patients, and central
superolateral in 2 patients. While the mean amount of excision was 567 g, the
highest excision was measured as 1912 g. Preoperative imaging of 96 patients
had BI-RADS-1 findings, 84 patients had BI-RADS-2 findings, and 10 patients had
BI-RADS-3 findings. Two patients were referred to general surgery because of
BIRADS-4a findings? in preoperative imaging. Patients were operated after the
biopsy results of general surgery were reported as fibroadenoma. Pathology
result was reported as normal breast tissue in 76 of 384 breasts. Non-proliferative
breast changes, the most common fibrocystic changes, were found in 275 patients
as a result of pathology. Eighteen patients had proliferative changes without
atypia, most commonly sclerosing adenosis. Ductal epithelial hyperplasia with
atypia was found in 11 patients and lobular hyperplasia with atypia was found
in 4 patients. Preoperative BI-RADS imaging of patients with atypia hyperplasia
varied as 2-3.
While 132 patients did not have any
problems in the postoperative period, 45 patients were followed up mostly with
dressing due to problems in wound healing, and 6 patients were resutured in
outpatient clinic conditions. Half of the patients were heavy smokers. Of the
patients who had complications 2 of them were non-smokers but their surgical
resection amount was between 500-1000. Debridement in the operating room due to
unilateral areola necrosis was performed in 1 patient, nipple reconstruction
was performed in the follow-ups, reduction mammoplasty was performed in 1
patient, revision surgery was performed in 2 patients due to asymmetry and dog
ear correction was performed in 2 patients. In 1 patient, hematoma was detected
in the early postoperative period, and the patient was re-operated on the same
day and the hematoma was drained. Localized hematoma was followed up without
surgery in 3 patients. Hypertrophic scar was observed in 5 patients and scar
revision was performed in one patient.
Discussion
Reduction mammoplasty is one of the
surgical procedures with a high patient satisfaction rate in the postoperative
period. Especially after high-volume tissue excision, the quality of life of
patients increase. Any patient who is scheduled for reduction mammoplasty,
regardless of age, should have appropriate preoperative imaging. If
pathological findings are detected in imaging, general surgery consultation
should be requested. Patients should be warned about the possibility of
asymmetry in the early postoperative period, circulation problems and smoking. It’s
important that patients’ pathology results are followed up in outpatients
clinics. It should be taken into account that early fat necrosis and hematoma
may cause suspicion of malignancy in postoperative screening, and if possible,
general surgery and radiology should be consulted.