Wise pattern breast reduction remains the most popular method of performing moderate- to large-sized breast reductions in the United States. Shape distortion after breast reduction can be a result of design flaw, execution of technique, or the result of postoperative complications. This article focuses primarily on optimal design and intraoperative techniques for prevention of shape distortion. By carefully considering the design of the skin resection pattern, choosing and designing an appropriate pedicle, preventing skin necrosis, and managing scars, shape distortion after Wise pattern breast reduction can be minimized.
Key points
- •
Design a Wise pattern with longer vertical limbs: 8 to 12 cm from nipple to inframammary fold.
- •
Limit undermining of skin flaps.
- •
Elevate skin flaps deep to the breast capsule to ensure perfusion.
- •
Create wide-based inferior pedicles.
- •
Establish tension-free closures by creating generous skin envelopes and performing a superficial fascial vertical closure.
Introduction
Wise pattern breast reduction remains the most popular method of performing moderate- to large-sized breast reductions in the United States. According to the American Board of Plastic Surgeons Maintenance of Certification tracer statistics from 2012, 83% of surgeons use a Wise pattern skin resection pattern for their primary technique. Despite the generalized acceptance that short scar techniques are good options for many patients and despite the universal desire to minimize scarring, the Wise pattern approach endures and remains widely taught and frequently used. This popularity is most likely because of the comfort level that surgeons have in applying this technique to all varieties and sizes of breast reductions and in achieving predictable results.
Inferior pedicle Wise pattern breast reductions have been criticized for creating flat boxy breasts that are prone to hypertrophic scarring from the ample scar burden. Without doubt, this technique may lead to these types of outcomes ( Fig. 1 ). Often the most challenging patients are addressed using this standard technique though, and outcomes may be associated as much with the degree of difficulty of the case as with the technique used. Every case should be done, however, with the goal of obtaining an aesthetically pleasing result and this should be achievable. The Wise pattern inferior pedicle breast reduction it is not a bad operation; but it can, like any other method of reduction, be done badly.
