Comparing Outcomes of Wise-Pattern, Two-Staged Breast Reduction-Reconstruction With and Without ADM
Ashraf A. Patel, BS1, Hana Kayaleh, BS1, Luke A. Sala, BS1, Dylan J. Peterson, BS2, Prashant K. Upadhyaya, MD1.
1SUNY Upstate Medical University, Syracuse, NY, USA, 2Stanford University, Palo Alto, CA, USA.
BACKGROUND: Aesthetic results in breast reconstruction for ptotic/obese breasts may be improved when utilizing Wise-pattern closures as compared to nipple-sparing mastectomies. This method combines breast reduction with the reconstruction to remove excess skin and reduce ptosis to improve cosmesis. However, this approach increases complication rates and has been critiqued for removing too much tissue, leaving little structure to support the prosthesis. Acellular dermal matrix (ADM) is commonly used to support the prosthesis, but our study tests the efficacy of an alternate technique that utilizes the de-epithelialized excess skin in lieu of ADM. To better understand whether ADM is necessary, we compare postoperative outcomes from reduction-reconstructions that utilized ADM to those that did not use ADM.
METHODS: This study retrospectively reviewed the outcomes of patients who underwent two-staged, implant-based breast reconstruction following Wise-pattern closures between September 2016 and October 2019. Two cohorts were created based on whether ADM was utilized in the reconstruction. Basic demographics, medical comorbidities, oncologic history, and perioperative information from both surgeries was collected for all patients. Charts were reviewed for incidence of any complication that occurred following both stages 1 and 2 of breast reconstruction. Multivariable logistic regressions were utilized to control for any cohort differences.
RESULTS: A total of 164 breasts were reconstructed following Wise-pattern closure in 85 female patients. The ADM cohort consisted of 68 breasts, whereas the Non-ADM cohort included 96 breasts. Mass of the resected specimen was similar in both cohorts (ADM: 814.7 grams vs. Non-ADM: 862.7 grams, p=0.304). Prepectoral tissue expander use was more prevalent in the Non-ADM cohort (ADM: 14.7% vs. Non-ADM: 33.3%, p=0.007), but multivariable regression did not find this to be a predictor of complication (p= 0.954). Following stage 1, incidence of ≥1 complication was similar between cohorts (p=0.684). Minor infection rates were significantly higher in reconstructions utilizing ADM (ADM: 16.2% vs. Non-ADM: 6.3%, p=0.040). Following stage 2, complication incidence was also similar between cohorts (p=0.638). Final follow up time was 445.2 days.
CONCLUSIONS: Overall complication rates following both stage 1 and 2 surgeries were similar when comparing reduction-reconstructions with and without ADM. When ADM was used, minor infection rates were higher following stage 1 surgery. Thus, we believe in patients desiring a reduction-reconstruction, the de-epithelialized dermal flaps provide ample support for the prosthesis without need for ADM. The Non-ADM cohort utilized more prepectoral reconstructions, making this method a viable option in both pre- and subpectoral reconstructions. 
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