What are the main types of skin closure patterns used in breast reduction surgery?

Main Types of Skin Closure Patterns in Breast Reduction Surgery

The three main types of skin closure patterns in breast reduction surgery are the Wise pattern (inverted T incision), vertical pattern (lollipop), and periareolar pattern. 1

Wise Pattern (Inverted T Incision)

• The Wise pattern, also known as the inverted T incision, is the most common skin reduction pattern used in breast reduction surgery in the United States 2
• This pattern creates an anchor-shaped scar with horizontal components along the inframammary fold and a vertical component extending to the areola 2
• The American Cancer Society notes that this pattern allows for significant tissue removal and is particularly useful for patients with severe ptosis or requiring large volume reductions 1
• While effective for tissue removal, this pattern is associated with higher rates of mastectomy flap necrosis and longer wound healing periods compared to vertical patterns 3

Vertical Pattern (Lollipop)

• The vertical pattern, sometimes called the "lollipop" incision, eliminates or significantly reduces the horizontal inframammary scar 4
• This pattern combines a periareolar component with a vertical scar extending from the areola to the inframammary fold 4
• Studies show the vertical pattern is associated with significantly less mastectomy flap necrosis and shorter wound healing periods compared to the Wise pattern 3
• The vertical pattern provides better breast projection and shape with minimal visible scarring 4
• A trend toward decreased overall complications has been observed with vertical pattern reductions, though this hasn't reached statistical significance in meta-analyses 2

Periareolar Pattern

• The periareolar pattern involves incisions confined to the border of the areola 1
• The American Cancer Society suggests that periareolar incisions are appropriate only for specific cases, particularly small lesions in the immediate subareolar area 1
• This pattern is considered inappropriate for lesions in the periphery of the breast 5
• The "round block" periareolar technique popularized by Benelli is one variation of this approach 4
• This technique may result in pleating of the periareolar incision if used alone, which is why it's often combined with other patterns 4

Technical Considerations for All Patterns

• The American Cancer Society recommends that the skin should be closed with a subcuticular technique to optimize cosmetic results 5
• Curvilinear skin incisions following Langer's lines (natural tension lines) generally achieve the best cosmetic results for any pattern 5
• Radial incisions may provide better results at the 3 o'clock and 9 o'clock positions and in the lower breast, particularly if skin removal is necessary 5
• Excision of skin segments should be avoided when possible as it may alter the position of the nipple or inframammary crease 5
• Meticulous hemostasis is critically important with all incision patterns to prevent hematoma formation 5

Pattern Selection Considerations

• The choice between patterns should consider factors such as breast size, degree of ptosis, body habitus, and the amount of tissue to be removed 2
• Larger breasts with significant ptosis traditionally favor the Wise pattern for its ability to manage excess skin 2
• Moderate sized breasts may benefit from the vertical pattern's improved projection and reduced scarring 4
• Small breasts with minimal ptosis may be candidates for the periareolar approach 1
• Hybrid approaches like the "owl" incision combine features of periareolar and vertical techniques to optimize outcomes 4