Mastectomy Incision Choice in Ptotic Patients Undergoing Immediate Implant Based Reconstruction: A Comparison of Wise and Oblique Elliptical Pattern
Katherine Chemakin*1, Joseph A. Ricci1, Teresa Benacquista1, Lawrence Draper1, Katie Weichman2
1Reconstructive & Plastic Surgery , Montefiore/Albert Einstein College of Medicine, Bronx, NY; 2Reconstructive & Plastic Surgery, NYU Langone Health, New York, NY
Breast ptosis presents challenges for implant-based reconstruction due to the large skin envelope. Skin-reducing mastectomy (SRM) reduces the envelope but must consider many other factors including complications. Limited data exists on incision impact on outcomes. We compare oblique eliptical and wise pattern incisions on complications and patient-reported quality of life in immediate implant-based reconstruction.
A retrospective review of patients who underwent immediate implant based SRM at a single institution from 2015 to 2021 was done and was divided into two cohorts: wise and oblique incisions. Demographics, complications, and patient reported outcomes (BREAST-Q) were compared. Descriptive, t-test, and chi-square test analyses, followed by adjusted linear and logistic regression models were performed to compare complication rates and BREAST-Q scores.
Eighty-nine patients were analyzed, 39 (43.8%) in the oblique (OI) and 50 (56.2%) in the wise (WI) cohort. No differences in demographics or pre-operative comorbidities between groups were found. The oblique incision patients had significantly more total complications (OI 2 vs WI 1; p=0.004), as well as increased incidence of explanation (OI 15 vs WI 3;p=0.003) and cellulitis (OI 14 vs WI 3;p=0.02) compared to wise group. Linear regression analysis revealed that incision choice was a significant predictor of complication rate (β= -1.06, 95% CI[-1.63- -0.50], p=<0.001). Logistic regression analysis showed that incision was a significant predictor of specific complications such as explanation (OR=0.10, 95% CI [0.02-0.52], p=0.006) and cellulitis (OR=0.16, 95% CI [0.03-0.73],p= 0.018); with decreased risk of choosing wise incision. There was no difference in BREAST-Q results.
Ptotic patients with oblique incision are associated with higher rates of postoperative complications compared to wise incisions. These findings suggest that incision choice is an important factor in post-operative complication development and emphasizes the need for further investigation and discussion with patients during preoperative planning.
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