Wise Pattern Direct Implant Breast Reconstruction: A Review and Improved Outcomes Using Dermal Matrix

Friedman, Henry L.; Talebagha, Sarah; Gilstrap, Jarom; Mujadzic, Mirsad; Chen, Elliott

doi:10.1097/gox.0000000000002439

Cited by 10 publications

(11 citation statements)

References 37 publications

(104 reference statements)

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“…Friedman et al [ 9 ] published a technique, where the caudal dermis flap was used in combination with ADM. As a finding, the failure rate was significantly higher and the technical and economical effort was rising, so we don`t recommend the use of the dermis flap in combination with synthetic mesh or ADM.…”

Section: Discussionmentioning

confidence: 99%

“…A T-scar reduction figure was designed as a surgical access for prophylactic mastectomy, depending on the expected implant size. The caudal part of the skin was deepithelialized according to the Wise pattern [ 9 ]. Leaving an adipodermal flap of 5 mm of thickness in average with preservation of the subdermal vascular plexus, the gland was then removed from the fascia.…”

Section: Methodsmentioning

confidence: 99%

“…Even women without genetic modification increasingly want prophylactic mastectomy of the contralateral breast after breast cancer, although close follow-up in these women is equivalent to surgery in terms of long-term survival. As long as no additional potential risk of disease is seen in their familial environment, these patients are not encouraged to undergo contralateral prophylactic mastectomy in accordance with the Contralateral Prophylactic Mastectomy (CPM) Consensus Statement of the American Society of Breast Surgeons [ 2 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Heine

Hoesl

Seitz

et al. 2021

Arch Gynecol Obstet

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Introduction The demand for prophylactic mastectomy has increased significantly over the last 10 years. This can be explained by a substantial gain of knowledge about the clinical risk and outcome of patients with high risk mutations such as BRCA1 and 2, the improved diagnostic possibilities for detecting the genetic predisposition for the development of breast cancer and the awareness for those mutations by health care professionals as well as patients. In addition to expander-to-implant reconstruction and microsurgical flap surgery, definitive immediate reconstruction with subpectoral insertion of breast implants is often preferred. The prosthesis is covered at its inferior pole by a synthetic mesh or acellular dermal matrix. In these cases, in addition to the silicone prosthesis, a further foreign body must be implanted. This can be exposed in the event of wound healing disorder or necrosis of the usually thin soft tissue covering after subcutaneous mastectomy, thus calling into question the reconstructive result. In this study, the coverage of the lower pole by a caudal deepithelialized dermis flap, which allows the implant to be completely covered with well vascularized tissue, is compared to coverage by a synthetic mesh or acellular dermal matrix. Patients and methods From January 2014 to June 2020, 74 patients (106 breasts) underwent breast reconstruction following uni or bilateral prophylactic mastectomy. Reconstruction was performed with autologous tissue (15 breasts), with tissue expander or implant without implant support (15 breasts), with implant and use of an acellular dermal matrix or synthetic mesh (39 breasts) and with implant and caudal dermis flap (37 breasts). In this study, we compared the patients with implant and dermal matrix/mesh to the group reconstructed with implant and dermal flap. Results In the group with the caudal dermis flap, 4 patients developed skin necrosis, which all healed conservatively due to the sufficient blood supply through the dermis flap. In the group with the use of a synthetic mesh or acellular dermal matrix, skin necrosis was found in three cases. In one of these patients the implant was exposed and had to be removed. Discussion For patients with excess skin or macromastia, the caudal dermis flap is a reliable and less expensive option for complete coverage of an implant after prophylactic mastectomy. In particular, the vascularized dermis flap can protect the implant from the consequences of skin necrosis after prophylactic mastectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Heine

Hoesl

Seitz

et al. 2021

Arch Gynecol Obstet

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“…In 1990, Bostwick described his technique utilizing excess skin in the ptotic breast at the time of mastectomy as a deepithelialized inferiorly-based dermal flap and closure of the breast pocket in a Wise pattern (48). The Bostwick "Autoderm" technique has been described in multiple variations since, as a way to manage a redundant breast pocket while utilizing well-vascularized flaps over prostheses or expanders (49)(50)(51)(52)(53)(54). Instead of disposing unnecessary lower pole tissue, the dermal flap becomes an essential part of the lateral and inferior pole borders and decreases the mechanical stress on mastectomy skin.…”

Section: Ptosismentioning

confidence: 99%

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Roubaud¹,

Carey²,

Vartanian³

et al. 2021

Gland Surg

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Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "highrisk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.

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“…6,7 Acellular dermal matrix has been used to help address this issue and has played a significant role in reconstruction, with uses in breast, abdominal, and burn operations. [8][9][10][11][12] It was first noted for use in breast reconstruction in 2005 and has since become an important tool in the reconstructive process. 13 In addition to providing support, studies suggest that the use of acellular dermal matrix alleviates capsular contracture and is thought to buttress the mastectomy flap.…”

mentioning

confidence: 99%

Comparing Outcomes of Wise-Pattern, Two-Stage Breast Reduction-Reconstruction with and without Acellular Dermal Matrix

Patel¹,

Kayaleh²,

Sala³

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Breast reconstructive techniques and technology have improved significantly in the past few decades, but reconstruction in obese and ptotic breasts continues to be a challenge when aiming for a successful reconstruction. Obesity inherently introduces additional risks for surgery, such as increased risk of developing postoperative infections and skin necrosis. [1][2][3] In addition, the excess skin also makes prosthesis placement difficult. Compared to nipple-sparing mastectomies, Wise-pattern closures may provide a better mastectomy approach in this patient population, as this removes the excess skin to minimize postreconstruction breast ptosis. 4,5 Although the "reduction-reconstruction" provides a better aesthetic result, this approach also has higher

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Wise Pattern Direct Implant Breast Reconstruction: A Review and Improved Outcomes Using Dermal Matrix

Cited by 10 publications

References 37 publications

Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Comparing Outcomes of Wise-Pattern, Two-Stage Breast Reduction-Reconstruction with and without Acellular Dermal Matrix

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