The over-Wise mammoplasty: a modified Wise pattern for large superficial breast tumors

Wise-pattern Split-reduction Incision to Facilitate Mastectomy and Direct-to-Implant Reconstruction for Superficial Breast Cancers

The split reduction allows for oncoplastic breast conserving surgery using a modified Wise-pattern closure in ptotic patients with cancers in close proximity to a skin margin. Although cancers involving skin within the Wise pattern are conveniently resected during closure, cancers in close proximity to skin outside the Wise pattern require a modified closure. This modified Wise-pattern closure preserves skin near the inferior pole of the breast which is normally resected and shifts this resection superiorly over the cancer. This also shifts the final medial or lateral inframammary scar onto the visible breast mound. Although this split-reduction Wise pattern has been well described for resecting advanced cancers in patients who undergo oncoplastic breast conserving surgery, this approach has not been described in patients who require mastectomy. Here, we report on 10 consecutive patients with ptosis and advanced breast cancers that require skin resection outside the standard Wise pattern, where we used the split-reduction incision to facilitate mastectomy and direct-to-implant reconstruction.

Breast-conserving surgery with the geometric compensation/split reduction technique. Indications, oncologic safety and cosmesis. A cohort series and systematic review of the literature

BACKGROUND

The Geometric Compensation Technique (GCT) and the Split Reduction Technique (SRT) enables breast conserving surgery (BCS) in selected patients with breast cancer initially candidates to mastectomy.

METHODS

Observational study of patients with breast cancer who underwent GCT consecutively treated. Evaluated retrospectively: indications, clinical characteristics, surgical features and recurrences. Cosmesis were evaluated prospectively by the BCCT.core software, Harris/Harvard and Garbay scales. Descriptive statistics were performed, chi-square test was used to compare aesthetic outcomes; Kappa and Weighted Kappa test was used to assess agreement between the postoperative evaluations; Kaplan-Meier model for follow-up and recurrence. A systematic review was carried out using PRISMA methodology.

RESULTS

Thirty-six patients were evaluated, 26 (72.2%) with medium/large breasts with or without ptosis, seven (19.4%) with small breasts with or without ptosis, a profile undergoing GCT not previously identified in the literature. The mean tumor clinical size was 3.65 ± 1.59 cm. 34 (94.4%) patients underwent GCT. Mean follow-up time was 36.6 ± 16.8 months, with no local recurrences. According to BCCT.core, the postoperative aesthetic was good in 17 (51.5%) patients and 11 (33.3%) was reasonable. In the systematic review, 3.584 articles were evaluated, 20 articles were selected, 243 patients undergoing GCT were found, with several indications for BCS instead of mastectomy, with high rates of free margins, low recurrence and good aesthetic outcomes.

CONCLUSION

GCT, an oncologically safe and aesthetically satisfactory option, has been extended to patients with small and medium breasts with ptosis, large tumors to breast volume or in unfavorable resection sites, initially candidates for mastectomy.