Comparing Different Methods Used for Prevention of T-Junction Dehisence in Wise Pattern Reduction Mammoplasty

Abstract

Introduction:The female breast is regarded as a symbol of femininity. The aesthetically pleasing breast will be of a size proportional to the body, be tear drop to conical in shape, and have the nipple positioned at the anterior most position. Deviations from normal size, shape, and symmetry are interpreted as unattractive. Wise pattern reduction mammoplasty is commonly used procedure for aesthetic and functional purposes. The use of the superomedial pedicle has increased over the past decade, as it has many reported benefits. The combination of the superomedial pedicle with the traditional Wise-pattern skin resection has gained increasing popularity for its versatility and ability to achieve significant aesthetic results. Wound problem complications remain relatively common, as well as the tendency of the outcome to deteriorate in some cases, with loss of projection and bottoming out of the lower breast pole. T-junction necrosis and infection are the most common complications encountered. The aim of this work is to compare between 2 modifications of Wise pattern technique for reducing T-junction dehiscence involving marking and incising an inverted V flap Along the Inframammary fold at the breast meridian and triangular lipodermal flap and finally to select the one of either technique to get the best results.Methods: This is a Prospective randomized comparative study including 30 female patients all complaining of breast hypertrophy and seeking reduction mammaplasty. The patients are divided randomly using a close envelope randomization method into 2 groups. Group (A) will include 15 patients to undergo Wise pattern reduction mammoplasty with inverted V flap. Group (B) will include 15 patients to undergo Wise pattern reduction mammoplasty with triangular lipodermal flap at the caudal end of the breast pillars.Follow-up is scheduled at the end of the first, second, and fourth postoperative weeks and checking the T junction for occurrence of dehiscence or not and assessing the degree of dehiscence. Patient satisfaction questionnaire then was presented to the patients.Results: The rate of major and minimal wound dehiscence was lesser in triangular lipodermal flap than in inverted V flap though statistically insignificant. Wound healing complications increased with increased BMI of the patients. Moreover, most of the patients were satisfied by overall outcomes with satisfaction rate of 93.3% in triangular lipodermal flap and 83.3% in inverted V flap. 275 Conclusion:The triangular lipodermal flap could be the future preferred technique as a modification to Wise pattern reduction mammoplasty for prevention or reduce the incidence of T junction complications.