{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T22:33:24Z","timestamp":1772058804925,"version":"3.50.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>As immediate direct to permanent implant-based breast reconstruction (IBBR) continues to gain in popularity, surgeons seek to apply these techniques to patients with large or ptotic breasts. A new bell pattern skin excision is described and limits major complications in this high-risk population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The authors describe a novel skin excision pattern for patients with large or ptotic breasts who desire IBBR and assess its safety. The authors also evaluated the ability of the pattern to account for intraoperative developments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective analysis of a single surgeon\u2019s experience included 17 consecutive patients (31 breasts) with large or ptotic breasts undergoing skin-reducing mastectomy with attempted utilization of the bell pattern approach and IBBR with acellular dermal matrix.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean age was 50 years, mean body mass index was 27.4 kg\/m2, and mean breast specimen weight was 683 g. A bell pattern excision was planned for all breasts preoperatively. Three breasts (10%) required an alternative closure pattern due to intraoperative ischemia (n = 1), or additional oncologic resection (n = 2). The pattern successfully accommodated flap ischemia in 8 (26%) other breasts. After a median follow-up of 5.1 months, the number of bell pattern breasts with major and minor complications was 0 (0%) and 9 (32%), respectively. The most common minor complication was seroma (n = 5, 18%), and minor incision wound (n = 3, 11%). There were no reconstruction failures utilizing the bell pattern.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The bell pattern approach is a safe and adaptable alternative to traditional skin-reducing mastectomy in patients with large or ptotic breasts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asjof\/ojz031","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T18:29:36Z","timestamp":1571855376000},"source":"Crossref","is-referenced-by-count":4,"title":["The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies"],"prefix":"10.1093","volume":"2","author":[{"given":"William B","family":"Albright","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J","family":"Hawkes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"2024070209010801000_CIT0001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.breast.2016.11.023","article-title":"Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes","volume":"32","author":"Ilonzo","year":"2017","journal-title":"The Breast."},{"key":"2024070209010801000_CIT0002","author":"American Society of Plastic Surgeons"},{"key":"2024070209010801000_CIT0003","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/PRS.0b013e3182729cde","article-title":"A paradigm shift in U.S. breast reconstruction: increasing implant rates","volume":"131","author":"Albornoz","year":"2013","journal-title":"Plast Reconstr Surg."},{"key":"2024070209010801000_CIT0004","first-page":"113L891","article-title":"Trends and concepts in post-mastectomy breast reconstruction","author":"Farhangkhoee","year":"2016","journal-title":"J Surg Onc."},{"key":"2024070209010801000_CIT0005","doi-asserted-by":"crossref","first-page":"448e","DOI":"10.1097\/PRS.0000000000000025","article-title":"Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction","volume":"133","author":"Kanuri","year":"2014","journal-title":"Plast Reconstr Surg."},{"key":"2024070209010801000_CIT0006","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.bjps.2017.02.028","article-title":"A systematic review of complications associated with direct implants vs. tissue expanders following Wise pattern skin-sparing mastectomy","volume":"70","author":"Corban","year":"2017","journal-title":"J Plast Reconstr Aesthet Surg."},{"key":"2024070209010801000_CIT0007","first-page":"175","article-title":"Systemic review of methodologies used to assess mastectomy flap viability","volume":"2","author":"Jeon","year":"2018","journal-title":"Brit J Surg."},{"key":"2024070209010801000_CIT0008","doi-asserted-by":"crossref","first-page":"284","DOI":"10.20517\/2347-9264.2016.48","article-title":"A mammometric 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