Outcomes after Wise-Pattern Mastectomy with the Inferior Dermal Flap in the Prepectoral Setting: A Systematic Review and Meta-Analysis.

Abstract

Patients with macromastia or ptosis undergoing mastectomy often require a Wise-pattern incision, yet this design carries increased risk of ischemic complications. The use of an inferior dermal flap ("autoderm") in the prepectoral plane has emerged as a strategy to provide vascularized implant coverage without acellular dermal matrix (ADM). A systematic search of PubMed, Embase, and Cochrane Library was performed through August 2025 in accordance with PRISMA guidelines. Eligible studies reported outcomes of Wise-pattern skin-sparing or skin-reducing mastectomy with dermal flap reconstruction in the prepectoral plane. Data on demographics, technique, and complications were extracted. Pooled proportions for major outcomes were estimated using random-effects meta-analysis. Ten studies comprising 287 patients and 464 breasts met inclusion. Most were single-institution case series; three were comparative cohorts. The pooled breast-level rate of implant loss was 4.8% (95% CI 3.8-6.0%; I² = 0%). Infection occurred in 7.5% (95% CI 4.8-11.4%; I² = 12%), and major mastectomy skin flap necrosis in 8.6% (95% CI 5.1-14.2; I 2 = 47.6%). Comparative studies found outcomes comparable to ADM-assisted reconstruction, though necrosis was higher with Wise-pattern mastectomies compared to mastectomies with elliptical incisions. Wise-pattern prepectoral reconstruction with a dermal flap demonstrates low rates of implant loss and infection. Ischemic complications were the most frequent adverse events reported. This approach may safely expand reconstructive options for obese or ptotic patients, though higher-quality prospective data are needed.