Wise-pattern Versus Transverse Pattern Mastectomy In Two-stage Implant-Based Breast Reconstruction: A Propensity Score-matched Analysis
Joseph M. Escandón, MD, James A. Butterfield, MD, Jose G. Christiano, MD, Jessica C. Gooch, MD, Anna Weiss, MD, Howard N. Langstein, MD, Oscar J. Manrique, MD, FACS.
University of Rochester Medical Center, Rochester, NY, USA.
PURPOSE: The wise pattern adapted to the mastectomy incisions has become a valuable asset for breast reconstruction in patients with large and ptotic breasts. Herein, we compared the time for exchange, time to initiate postmastectomy radiotherapy (PMRT) and complications rate between reconstructions performed with wise pattern versus a transverse incision pattern.
METHODS: We retrospectively reviewed the record of patients who underwent immediate two-stage implant-based reconstruction (IBBR) between January 2011 and December 2020. Two cohorts were compared according to the incision pattern: wise versus transverse incision pattern. Complications were compared after propensity score matching.
RESULTS: We initially analyzed 393 two-stage immediate IBBR in 239 patients, 91 (23.2%) in the wise-pattern group and 302 (76.8%) in the transverse pattern group. The expansion time (53 days versus 50 days, p=0.9), the time for TE-to-implant exchange (154 versus 175 days, p=0.547), and the time to initiate PMRT (144 days versus 126 days, p=0.616) were not different between groups. Before propensity score matching, the 30-day rate of wound-related complications (32% versus 10%, p<.001) and 30-day rate of wound complications requiring E/D+C procedures (20% versus 7%, p<.001) were significantly higher in the wise-pattern group. After propensity score matching, the 30-day rate of wound-related complications persisted significantly higher (25% versus 10%, p=0.03) in the wise-pattern group.
CONCLUSION: The wise pattern mastectomy independently increases the incidence of wound-related complications versus only transverse patterns during two-stage IBBR, even after propensity score matching. Delayed TE placement may improve the safety profile of this procedure.
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