Comparing Different Methods Used for Prevention of T-Junction Dehisence in Wise Pattern Reduction Mammoplasty

Abstract

Introduction: The female breast is regarded as a symbolof femininity. The aesthetically pleasing breast will be of asize proportional to the body, be tear drop to conical in shape,and have the nipple positioned at the anterior most position.Deviations from normal size, shape, and symmetry are interpretedas unattractive. Wise pattern reduction mammoplastyis commonly used procedure for aesthetic and functionalpurposes. The use of the superomedial pedicle has increasedover the past decade, as it has many reported benefits. Thecombination of the superomedial pedicle with the traditionalWise-pattern skin resection has gained increasing popularityfor its versatility and ability to achieve significant aestheticresults. Wound problem complications remain relativelycommon, as well as the tendency of the outcome to deterioratein some cases, with loss of projection and bottoming out ofthe lower breast pole. T-junction necrosis and infection arethe most common complications encountered. The aim of thiswork is to compare between 2 modifications of Wise patterntechnique for reducing T-junction dehiscence involving markingand incising an inverted V flap Along the Inframammaryfold at the breast meridian and triangular lipodermal flap andfinally to select the one of either technique to get the bestresults.Methods: This is a Prospective randomized comparativestudy including 30 female patients all complaining of breasthypertrophy and seeking reduction mammaplasty. The patientsare divided randomly using a close envelope randomizationmethod into 2 groups. Group (A) will include 15 patients toundergo Wise pattern reduction mammoplasty with invertedV flap. Group (B) will include 15 patients to undergo Wisepattern reduction mammoplasty with triangular lipodermalflap at the caudal end of the breast pillars.Follow-up is scheduled at the end of the first, second,and fourth postoperative weeks and checking the T junctionfor occurrence of dehiscence or not and assessing the degreeof dehiscence. Patient satisfaction questionnaire then waspresented to the patients.Results: The rate of major and minimal wound dehiscencewas lesser in triangular lipodermal flap than in inverted Vflap though statistically insignificant. Wound healing complicationsincreased with increased BMI of the patients.Moreover, most of the patients were satisfied by overalloutcomes with satisfaction rate of 93.3% in triangular lipodermalflap and 83.3% in inverted V flap.275Conclusion: The triangular lipodermal flap could be thefuture preferred technique as a modification to Wise patternreduction mammoplasty for prevention or reduce the incidenceof T junction complications.