Shaping of DIEP Flaps with the Help of the Wise Pattern in Immediate Breast Reconstruction

In breast reconstruction, shaping of the transferred flap may be finalized either during the initial procedure or later at another session. However, most of the time, the contralateral breast requires an intervention to acquire symmetry. In this study, the Wise pattern was used as an anchor for size equity in both the reconstructed and reduced (contralateral) breasts, in order to obtain adequate symmetry in one session in immediate reconstructions with deep inferior epigastric artery (DIEP) flaps.

DIEP flaps were used in 9 patients for immediate breast reconstruction. The average patient age was 45 years, and all patients had ptotic (and/or large) contralateral breasts. First, the oncologic surgeon marked the amount of skin he was planning to remove during the mastectomy. Next, the Wise pattern was marked over as if a bilateral reduction mammaplasty/mastopexy procedure was going to be performed. This enabled to seeing the amount of final skin defect at the mastectomy site (the Wise flap areas that overlapped the oncologic surgeon's would be resected sites). During the operation, mastectomy was performed in a reduction mammaplasty format,but with the inclusion of the oncologically premarked skin areas and the areola. The remaining Wise flaps on that side were closed, as in reduction mammaplasty and the remaining skin defect and breast volume were reconstructed with a DIEP flap. Then, contralateral reduction/mastopexy was performed.

There was no free flap loss. A marginal skin necrosis (1.0 x 0.5 cm) was observed at the distal edge of the lateral Wise flaps in two cases due to excessive use of cautery during mastectomy. These areas were debrided and closed primarily. Symmetry was achieved in all cases in a single session.

A primary determinant of breast volume and shape is the surface area and topographic location of the skin envelope. By equalizing the latter two variables between the reconstructed and contralateral breasts with the help of the Wise pattern, one–stage symmetry may be obtained in breasts reconstructed with the DIEP flap.