Effects of Wise Pattern versus Vertical Approach on the Outcomes of Superomedial Pedicle Breast Reduction: Systematic Review and Pooled Analysis.

Abstract

Superomedial pedicle breast reduction combined with a Wise pattern or vertical skin resection has become more popular recently. This review aimed to investigate the role of the type of skin resection that may alter the outcomes of superomedial breast reduction operations. The authors reviewed MEDLINE and Embase for studies on superomedial pedicle breast reduction outcomes, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. They used search terms related to "breast reduction" and "complications," and analyzed data with SPSS software. To reduce bias, they matched body mass index, excised tissue mass, and patient age. Complications noted included areolar necrosis, infection, wound dehiscence, hypertrophic scarring, altered sensation, seroma, hematoma, fat necrosis, dog-ear deformities, and delayed healing. A total of 332 articles were screened, resulting in 90 full-text evaluations and 42 studies included, involving 9525 breasts in 4848 patients. The crude complication rate was higher with the vertical approach (15.12%) compared to Wise pattern closure (12.21%; P < 0.001). After adjusting for confounders, rates were 17.97% and 12.79%, respectively ( P < 0.001). Subgroup analysis revealed significantly more partial and total nipple necrosis, infections, wound dehiscence, and other complications in the vertical approach ( P < 0.05). Conversely, altered sensation was more common in the Wise approach ( P < 0.001). Delayed wound healing rates were similar ( P = 0.666). Vertical skin closure has more complications than Wise pattern techniques but yields fewer cases of altered sensation. Both patients and surgeons should select the approach based on patient goals, while considering the associated complications.