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

Introduction: The female breast is regarded as a symbol
of femininity. The aesthetically pleasing breast will be of a
size 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 interpreted
as unattractive. Wise pattern reduction mammoplasty
is commonly used procedure for aesthetic and functional
purposes. The use of the superomedial pedicle has increased
over the past decade, as it has many reported benefits. The
combination of the superomedial pedicle with the traditional
Wise-pattern skin resection has gained increasing popularity
for its versatility and ability to achieve significant aesthetic
results. Wound problem complications remain relatively
common, as well as the tendency of the outcome to deteriorate
in some cases, with loss of projection and bottoming out of
the lower breast pole. T-junction necrosis and infection are
the most common complications encountered. The aim of this
work is to compare between 2 modifications of Wise pattern
technique for reducing T-junction dehiscence involving marking
and incising an inverted V flap Along the Inframammary
fold at the breast meridian and triangular lipodermal flap and
finally to select the one of either technique to get the best
results.
Methods: This is a Prospective randomized comparative
study including 30 female patients all complaining of breast
hypertrophy and seeking reduction mammaplasty. The patients
are divided randomly using a close envelope randomization
method into 2 groups. Group (A) will include 15 patients to
undergo Wise pattern reduction mammoplasty with inverted
V flap. Group (B) will include 15 patients to undergo Wise
pattern reduction mammoplasty with triangular lipodermal
flap 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 junction
for occurrence of dehiscence or not and assessing the degree
of dehiscence. Patient satisfaction questionnaire then was
presented to the patients.
Results: The rate of major and minimal wound dehiscence
was lesser in triangular lipodermal flap than in inverted V
flap though statistically insignificant. Wound healing complications
increased with increased BMI of the patients.
Moreover, most of the patients were satisfied by overall
outcomes with satisfaction rate of 93.3% in triangular lipodermal
flap and 83.3% in inverted V flap.
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Conclusion: The triangular lipodermal flap could be the
future preferred technique as a modification to Wise pattern
reduction mammoplasty for prevention or reduce the incidence
of T junction complications.