Ideal Tumor Locations for Wise Pattern Incision in Breast Cancer Surgery
The Wise pattern incision is ideally suited for tumors located in the upper outer and upper inner quadrants of the breast, particularly in women with moderate to severe breast hypertrophy (bra cup size C to E). 1, 2
Primary Indications by Tumor Location
Upper Quadrant Tumors (Optimal Candidates)
Upper outer quadrant tumors represent the most common indication, as this is both the most frequent site of breast cancer and an area where the modified Wise pattern can be readily adapted without requiring secondary or extended pedicles. 2
Upper inner quadrant tumors are particularly well-suited because this is the most cosmetically sensitive area of the breast, and the Wise pattern allows for oncologically sound resection while maintaining aesthetic outcomes in the décolleté region. 1, 2
The technique permits direct excision of skin overlying the tumor in upper quadrants while preserving a similar-size area from the lower pole to replace the removed tissue, maintaining natural breast shape. 1
Patient Selection Criteria
Breast size is critical: The Wise pattern approach is specifically designed for patients with moderate to severe breast hypertrophy (bra cup sizes C to E), as smaller breasts lack sufficient tissue volume for the redistribution required by this technique. 1
The method combines oncological quadrantectomy with immediate breast reconstruction and contralateral breast reduction to achieve symmetry. 1
Locations to Avoid
Central quadrant tumors involving the nipple-areola complex require different oncoplastic approaches (such as modified hemibatwing) rather than the standard Wise pattern. 3
Peripheral lesions are not appropriate for periareolar or Wise pattern approaches, as these do not provide adequate exposure and may compromise achievement of negative margins. 4
Lateral and medial lesions in the breast periphery are better served by curvilinear incisions placed directly over the lesion following Langer's lines. 4
Technical Advantages for Upper Quadrants
The Wise pattern scars (similar to reduction mammaplasty scars) do not aesthetically disfigure the décolleté when used for upper quadrant resections, unlike traditional radial incisions that can create visible deformities. 1
Natural breast shape is consistently achieved with this approach in appropriately selected patients, with the medial or lateral scar on the upper quadrant remaining cosmetically acceptable. 1
Important Caveats
Skin flap necrosis risk: The Wise pattern mastectomy incision carries significantly higher rates of skin flap necrosis (38.9%) compared to standard horizontal elliptical incisions (8.9%), though this does not translate to higher rates of revisional procedures. 5
For larger lesions in the lower breast, a radial incision may actually result in better cosmesis than attempting to adapt the Wise pattern. 4
The incision must always be placed so it can be easily incorporated within the mastectomy specimen if negative margins cannot be achieved with breast conservation surgery. 4