Effects of Wise Pattern Versus Vertical Approach on The Outcomes of Superomedial Pedicle Breast Reduction: Systematic Review and Pooled Analysis

Introduction: Superomedial pedicle breast reduction combined with a Wise pattern or vertical skin resection has become more popular recently. This review aims to investigate the role of the type of skin resection that may alter the outcomes of superomedial breast reduction surgeries. Methods: We reviewed MEDLINE and Embase databases for articles investigating superomedial pedicle breast reduction outcomes. Studies were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main search terms were synonyms of “breast reduction” and “complications”. Outcomes and complications were analyzed using SPSS statistical software. BMI, excised tissue mass, and patient age on operation were matched to decrease bias. Complications included areolar necrosis, infection, wound dehiscence, hypertrophic scarring, altered sensation, seroma, hematoma, fat necrosis, dog ear deformities, and delayed healing. Results: 332 papers underwent abstract screening, and 90 underwent full-text screening. 42 studies were extracted to yield 9,525 breasts in 4,848 patients. The mean age was 41.9 ± 5.33 years. The mean BMI was 28.7 ± 3.06. The mean mass of excised breast tissue on one side was 787.3 ± 352.43 grams. The crude incidence of complications with the vertical approach was significantly higher than with the Wise pattern closure (15.12% vs 12.21%, p<0.001). The difference increased following adjusting the confounders to (17.97% vs 12.79%, p<0.001). The subgroup analysis between the two adjusted groups showed a significantly higher incidence of partial and total nipple necrosis, infection, wound dehiscence, widened and hypertrophic scars, seroma, hematoma, fat necrosis, dog ear deformity, and the number of revisions in vertical approach (p<0.05). On the other hand, it showed a significantly higher incidence of altered sensation in the Wise pattern approach (p<0.001). Delayed wound healing rate was insignificantly different between the two groups (p = 0.666). Discussion: Vertical skin closure is associated with more significant complications than Wise pattern techniques. However, it is associated with a lower rate of altered sensation. Both patients and surgeons should choose the preferable approach based on the patient’s goals, keeping an eye on the anticipated complications aligned with each technique.