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Revision of Wise Pattern Breast Reductions with Vertical Procedures
Mark Sultan, M.D., Mark L. Smith, M.D., Joseph Dayan, M.D., William Samson, M.D..
Continuum Health Partners, New York, NY, USA.

BACKGROUND:
The vast majority of patients who undergo Wise pattern mammoplasties are satisfied with their initial results and likely remain so indefinitely. However, small percentages present requesting revisions. Patient goals may then include correction of recurrent (or residual) macromastia, recurrent ptosis, and/or poor breast shape. Previously, we have re-utilized the Wise pattern method with its reliance on breast skin modifications in such patients. However, we have often been disappointed with the aesthetic results of these revisions. Recently, in a series of these patients we have utilized vertical techniques with glandular reshaping to perform these revisions and have seen significant improvement in our results. Advantages having included uniformly more youthful, conical contours, narrowing of overly wide breasts and the avoidance of reopening mature, potentially problematic inframammary scars.
METHODS:
In the past four years fifteen patients have been managed in this manner. Thirteen were bilateral procedures and two unilateral with the latter being balancing procedures in women who had undergone contralateral breast reconstruction, In eight patients the revisions were considered to be mastopexies (less than 150 grams resected). The average number of years from the original procedure to the revision was 12.6 (range 3 to 25). The average age of the patients was 47 years (range 25 to 65). Information regarding the pedicle used during the first procedure was requested in all but available in only four patients (all were inferior pedicles). Our vertical mammoplasties utilized a superior, superomedial or a combination of the two pedicles in all patients. The nipple/areola complex transposition distance was small in all patients. The resection weights were small as well, averaging 252 grams (range 155 to 361 grams) but were supplemented by axillary liposuction in all patients. Two of the patients undergoing mastopexies required or requested simultaneous implant placement.
RESULTS:
One patient developed epidermolysis of one nipple/areola complex which healed fully with conservative care. There were no other instances of vascular compromise of the nipple/areola complexes and there were no other complications. Patients have been uniformly pleased with the significant improvement in their breast contour, width and size. Most were also happy to avoid reuse of inframammary scars which in many instances had previously taken years to mature.
CONCLUSIONS:
In summary, despite use of the Wise pattern method for the original procedure, consideration should be given to use of vertical techniques for revisions in that they are safe and can better address patient goals. Gratifying results can be achieved.


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