Comparing Wise Pattern to Non-Wise Pattern Skin-Sparing Mastectomy: A Critical Evaluation of Patient Demographics and Surgical Outcomes.

Abstract

Multiple skin-sparing incisions are used in immediate postmastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large, ptotic breasts compared with the non-Wise pattern incision (NWPI). The authors evaluated patient demographics and surgical outcomes with WPI versus NWPI. An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code Z42.1: "Encounter for breast reconstruction following mastectomy." Retrospective chart review evaluated patient demographics, intraoperative factors, postoperative complications, and surgical cost. A total of 288 patients were included: 58 underwent WPI and 230 underwent NWPI. Median body mass index (BMI) differed between WPI (30.5 kg/m 2 ) and NWPI (26.4 kg/m 2 ) ( P < 0.001). Fifty-seven percent of WPI had preoperative grade 3 ptosis versus 23% of NWPI ( P < 0.001). No difference was found in median operative times (WPI, 219 minutes; NWPI, 194 minutes; P = 0.38). Overall rates of postoperative complications differed between WPI (62%) and NWPI (45%) on univariate but not multivariate analysis. Median total surgery charge was higher for WPI (WPI, $36,223; NWPI, $31,185; P < 0.001), whereas implant cost was higher for NWPI (WPI, $2700; NPWI, $8040; P < 0.001). There was no significant difference in operative time, overall complication rate, or charge between incision types once adjusted for confounding factors. The higher complication rate in the WPI group was likely driven by higher BMI, a known risk factor for surgical complications regardless of approach. Surgeons can consider WPI as a noninferior option for patients with higher BMI and ptosis. Therapeutic, III.