Efficacy of double mirrored omega pattern for skin sparing mastectomy to reduce ischemic complications

Background: Excellent cosmetic results from skin-sparing mastectomy (SSM) are often impaired by skin flaps' necrosis (SFN), from 8%-25% or worse in smokers. This study prospectively investigated the efficacy of Double-Mirrored Omega Pattern (DMOP-SSM) compared to Wise Pattern SSM (WP-SSM) for immediate reconstruction in moderate/large-breasted smokers.Methods: From 2008-2010, DMOP-SSM was performed in 51 consecutive immediate breast reconstructions on 41 smokers (mean age = 49.8 years) with moderate/large and ptotic breasts. This active group (AG) was compared to a similar historical control group (CG) of 37 smokers (mean age = 51.1years) who underwent WP-SSM and immediate breast reconstruction, with a mean follow-up of 37.6 months. Skin ischaemic complications, number of surgical revisions, time to wound healing, and patient satisfaction were analysed. Descriptive statistics were reported and comparison of performance endpoints was performed using Fisher's exact test and Mann-Whitney U-test. A p-value < .05 was considered significant.Results: Patients' mean age (p = .316) and BMI (p = .215) were not statistically different between groups. Ischaemic complications occurred in 11.7% of DMOP-SSMs and in 32.4% of WP-SSMs (p = .017), and revision rates were, respectively, 5.8% and 24.3% (p = .012), both statistically significant. Mean time to wound healing was, respectively, 16.8 days and 18.4 days (p = .205). Mean patients' satisfaction scores were, respectively, 18.9 and 21.1, statistically significant (p = .022).Conclusion: Although tobacco use in moderate/large breasted patients can severely impair outcomes of breast reconstruction, the DMOP-SSM approach, compared to WP-SSM, allows smokers to benefit from SSM, but with statistically significant reduced skin flaps ischaemic complications, revision surgery, and better cosmetic outcomes.