The over-Wise mammoplasty: a modified Wise pattern for large
superficial breast tumors
Received: 18 January 2016 /Accepted: 9 August 2016 / Published online: 26 August 2016
Springer-Verlag Berlin Heidelberg 2016
Background Large breast tumors in the upper quadrants of the
breast pose a great challenge to the oncoplastic surgeon.
Standard mammoplasty techniques cannot be used, and re-
placement techniques with local flaps may be too small or
too risky. We present a safe and simple modification of the
standard Wise pattern that allows for large resections includ-
ing skin in the upper quadrants.
Methods From 2011 to 2014, a series of women with large
tumor areas in the upper lateral quadrant were treated with
breast-conserving surgery and the over-Wise mammoplasty.
Pre- and postoperative data were recorded and cosmetic and
oncologic outcome evaluated.
Results Thirteen women were operated on using the over-
Wise technique, all with a cosmetically satisfactory result.
The complication rate in the affected breast was 7.7 %.
Conclusions The over-Wise mammoplasty offers a simple so-
lution to a complex problem, in that it allows very large resec-
tions of superficial tumors in the upper quadrants, with mini-
mal risk and excellent cosmetic results.
Level of evidence: Level IV, therapeutic study.
Keywords Breast cancer
Many women with breast cancer have large tumors at the time
of presentation . In spite of today’s excellent results after
mastectomy and primary reconstruction, many of these wom-
en insist on breast-conserving surgery (BCS) [2, 3]. The larger
the resection volume in relation to breast size, the greater the
importance of oncoplastic knowledge, aesthetic understand-
ing, and dexterity of the surgeon [4, 5]. Large tumors located
within the classic Wise pattern are easily resected using com-
monly known breast reduction techniques [6–8], whereas
treatment of tumors in the upper quadrants can be more chal-
lenging, especially if there is a need for skin resection. One
may choose breast reduction techniques with extended or sec-
ondary pedicles or flaps from the thoracic wall [9–11]. These
techniques involve flap rotation, which means that they carry
a risk of flap necrosis, and, in case of involved margins, it may
be impossible to locate the primary tumor site for re-resection.
We present a simplified oncoplastic technique for women
with ptotic breasts who have large superficial tumors in the
upper quadrants, with easy planning, short operation time,
minimal risk of complications, and excellent cosmetic results.
Patients and methods
Patients with large radiologically and histologically verified
tumor areas (invasive or in situ) in the upper outer quadrants
were selected for BCS and the over-Wise mammoplasty.
Inclusion criteria were the following: women with tumors up
to 50 mm, multifocal cancer within the quadrant, tumors with
surrounding ductal carcinoma in situ (DCIS), or large areas of
* Lena Carstensen
Department of Breast Surgery, Ringsted Hospital,
Department of Breast Surgery, Sydvestjysk Sygehus,
Eur J Plast Surg (2017) 40:195–202