Excess Horizontal Breast Skin Facilitates a Simpler Wise Pattern Split Reduction Incision for Superficial Cancers

The Wise pattern split reduction (WPSR) incision is useful in patients with cancers near a skin margin that lies outside of the standard pattern. Instead of resecting skin in the standard inferolateral or inferomedial sections of the breast, this modified Wise pattern preserves this skin and instead resects skin over the tumor, ensuring a clear anterior margin and shifting the scar onto the breast instead of the medial or lateral inframammary fold. This approach makes use of the excess vertical skin of the breast. We have found that in certain situations, a WPSR incision can instead rely on the excess horizontal skin of the breast (the skin between the preoperatively drawn medial and lateral vertical limbs). This modification is useful for superficial, smaller, less extensive cancers that lie just medial or lateral to the preoperative Wise pattern vertical limb markings, resulting in a smaller final scar and a less extensive and complex surgical procedure. Patients with breast cancer were recruited into this study retrospectively after either a preoperative or intraoperative decision was made to use a WPSR incision using horizontal skin excess. This report summarized our experience with 10 consecutive patients who successfully underwent this approach to facilitate a clear anterior margin.