“Wise Pattern Skin-Sparing Mastectomy with Two-Stage Implant-Based Breast Reconstruction Among Patients with Breast Ptosis”

BACKGROUND: Wise pattern mastectomy has emerged as a popular alternative to transverse pattern mastectomy for patients with moderate-to-severe breast ptosis and macromastia. However, there is a knowledge gap regarding reconstructive outcomes. In this study, we compared complication and revision rates among patients with breast ptosis undergoing Wise pattern versus transverse pattern skin-sparing mastectomy with immediate two-stage implant-based breast reconstruction. METHODS: In this single-center retrospective cohort study, female patients with Regnault grade II or III breast ptosis who underwent skin-sparing mastectomy with immediate tissue expander placement from 2019-2023 were included. Bivariate analyses were conducted to compare Wise pattern and transverse pattern mastectomy cohorts. Multivariable analyses were performed to evaluate complication and revision rates. RESULTS: A total of 200 patients met the inclusion criteria, with 125 and 75 patients in the transverse pattern and Wise pattern groups, respectively. In multivariable analysis, Wise pattern mastectomy was not associated with minor complications and was associated with decreased odds of major complications (OR 0.285, 95% CI 0.120-0.679, p=0.005). Moreover, Wise pattern mastectomy was associated with decreased odds of undergoing breast revision (OR = 0.247, 95% CI 0.117-0.523, p<0.001) and decreased odds of a higher number of total revisions on ordinal logistic regression (OR = 0.231, 95% CI 0.110-0.487, p<0.001). CONCLUSIONS: For patients with moderate-to-severe breast ptosis undergoing immediate two-stage implant-based breast reconstruction, Wise pattern mastectomy was associated a similar complication profile and reduced revision burden compared with transverse pattern mastectomy. Prospective multicenter studies incorporating patient-reported outcome measures are warranted.