Plastic Surgery Research Council
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ANALYSIS OF THE VERTICAL MAMMAPLASTY INCISION APPROACH TO SKIN-SPARING MASTECTOMY AND IMMEDIATE AUTOLOGOUS TISSUE RECONSTRUCTION
Presenter: Ahuja Naveen
Co-Authors: Gimbel ML; Smith DA
University of Pittsburgh Medical Center

Skin-sparing mastectomy designs for immediate autologous tissue reconstruction include racquet, Wise, and vertical mammoplasty incisions. In ptotic breasts, racquet incisions do not address ptosis and Wise-patterns have high mastectomy flap necrosis risk. The vertical design addresses ptosis while maintaining viable skin flaps. This study compares the racquet to the vertical incision in autologous breast reconstruction.Skin-sparing autologous breast reconstructions by a single surgeon employing either vertical or racquet incisions from 08/2006 to 09/2011 were analyzed. Aesthetic scoring was based on a Likert-scale assessment of scar appearance, shape, preoperative versus postoperative aesthetic comparison, and overall aesthetic outcome by evaluators unaware of operative technique. Responses were analyzed using the Mann-Whitney Test. 77 patients (48 racquet, 29 vertical) were included. Vertical designs were used for breasts with higher grade ptosis (p=0.0006). Patient demographics and complications did not differ. Vertical design reconstructions had significantly better appearing scars (3.76 vs 3.50; p=0.0359). Vertical design reconstructions also showed a trend toward significance in cosmetic improvement compared to preoperative appearance (3.20 vs 3.00; p=0.0634). There was no difference in shape (vertical 3.55, racquet 3.56; p=0.8581) or in postoperative aesthetic result (vertical 3.55, racquet 3.40; p=0.4121). Final shape and overall postoperative aesthetic appearance did not significantly differ despite the more ptotic breasts preoperatively in the vertical group, suggesting that the vertical approach is at least as effective as the racquet design. We were impressed that the vertical design reconstructed breasts were rated aesthetically superior to their pre-mastectomy appearance, a reconstructive triumph. Significantly better scar scores in the vertical group reflect the camouflaged nature of vertical incisions. These results demonstrate that vertical reconstruction of ptotic breasts is as good as and potentially superior to the traditional racquet reconstruction of non-ptotic breasts.


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