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Zhu et al. Modified Robertson vs. Wise pattern

Table 4: Change over time
Modified robertson reduction Wise pattern reduction
ROB (range) WISE (range) P value
A B E F SNtoNIP (cm) 1.31 (0.60-2.31) 0.44 (-0.52-2.10) 0.00*
NIPtoIMF (cm) 0.88 (-1.25-3.26) 0.27 (-0.76-1.82) 0.05*
NIPtoNIP (cm) 1.20 (-1.21-6.98) -0.26 (-1.66-0.87) 0.09
C D G H
NipProj (cm) 0.69 (-0.80-2.00) -0.26 (-2.15-1.81) 0.00*
MaxProj (cm) -0.02 (-1.85-1.43) -0.15 (-2.24-2.01) 0.67
AreolaSA (cm ) 3.08 (-7.13-9.81) 2.59 (-3.86-10.14) 0.77
2
61.2% 62.6% 64.1% 63.1%
38.8% 37.4% 35.9% 36.9% BreastSA (cm ) 4.00 (-31.83-50.46) -2.89 (-29.50-36.55) 0.28
2
TotVol (mL) 46.7 (-112.7-170.5) -20.1 (-168.1-216.5) 0.04*
Early postoperative Late postoperative Early postoperative Late postoperative
period period period period SupPole% 3.36 (-4.06-7.82) 1.42 (-11.16-22.05) 0.28
Figure 3: Example images. Patient photographs and 3D MedPole% 2.57 (-8.16-12.39) 1.36 (-17.94-17.96) 0.60
reconstruction images showing volumetric analysis. Images *Statistically significant
A-D are from the same ROB patient (age: 31 years) and images
E-H are from the same WISE patient (age: 26 years). (A) AP
photograph of ROB breasts at early postoperative time period; (B) aesthetically preferred over the 50:50 ratio. It is possible
AP photograph of ROB breasts at late postoperative time period; that the superior breast apron of the modified Robertson
(C) 3D reconstruction lateral view of left breast of ROB patient at technique supports the inferior pedicle and maintains
early postoperative period showing 61.2% superior pole volume; (D)
3D reconstruction lateral view of left breast of ROB patient at late superior pole volume without the presence of a vertical
postoperative period showing superior pole volume of 62.6%; (E) AP incision in the Wise pattern technique.
photograph of WISE breasts at early postoperative time period; (F)
AP photograph of WISE breasts at late postoperative time period;
(G) 3D reconstruction lateral view of left breast of WISE patient at In addition, the Wise technique demonstrated greater
early postoperative period showing 64.1% superior pole volume; (H) medial pole volume by approximately 17% and greater
3D reconstruction lateral view of left breast of WISE patient at late maximum breast projection by 1 cm. The presence of a
postoperative period with superior pole volume of 63.1%
vertical scar may distribute the inferior pedicle medially
and narrow the width of the breast, leading to improved
Robertson and Wise patterns for inferior pedicle breast projection. The vertical incision may also prevent
reduction mammoplasty. Movassaghi et al. directly lateral migration of the nipple position as demonstrated
[15]
compared the two skin patterns in breast reduction; by the smaller internipple distance in the Wise pattern
however, their analysis focused on complication rates cohort (21.3 cm WISE vs. 24.8 cm ROB, P < 0.01).
of hematoma, minor wound dehiscence, and scar
hypertrophy. They found a reduced complication rate The total breast volume of the modified Robertson cohort
in the modified Robertson technique with decreased increased over time (+47 mL), whereas the Wise cohort
skin breakdown, since this skin pattern does not have decreased (-20 mL). It is possible that these changes
an intersecting triple point. Chalekson et al. evaluated reflect systemic changes in the patient with weight
[3]
morphologic outcomes of modified Robertson patients; and/or menstrual cycle. This change in total volume
however, they compared the results to aesthetically is consistent with an increase in notch to nipple and
optimal breasts, instead of other reduction patients. nipple to IMF measurements in the modified Robertson
Their recorded outcomes included patient satisfaction, cohort. An increase in overall volume of the breast may
symptom reduction, scarring, nipple position, ptosis, also explain the increase in nipple projection found in
pseudoptosis, shape, and overall appearance the modified Robertson cohort. In contrast, the Wise
several years following surgery. They found excellent cohort had a decrease in total volume over time, which
satisfaction among patients and no difference between is also consistent with the decrease in nipple projection
their reduction patients and aesthetically ideal patients and maximum breast projection.
with regards to pseudoptosis.
The modified Robertson cohort consistently
Using 3D analysis to compare the late postoperative demonstrated longer nipple to IMF distances compared
result of the modified Robertson to the Wise pattern to the Wise pattern, and this can be explained by the
breast reduction, the modified Robertson technique surgeon preference to widen the skin bridge of the
demonstrated greater superior pole volume by breast apron below the areola to minimize ischemic
approximately 5%. This difference was both statistically complications.
and clinically significant. Previous research by
Mallucci et al. analyzed breast photographs with 5% The areola surface area was consistently larger in
[24]
differences in superior to inferior pole ratio to determine the modified Robertson cohort compared to the Wise
ideal breast shape, finding that the 45:55 ratio was pattern cohort at all time points. Both surgeons
288 Plastic and Aesthetic Research ¦ Volume 3 ¦ September 20, 2016