A standard Wise-pattern reduction can be used to excise a breast cancer that falls within the Wise pattern.1 When the tumor is located outside the Wise pattern, it can be removed by tunneling and pulling the lesion through the Wise-pattern incision. When it is necessary to take skin overlying the tumor, the Wise pattern can be reconfigured by moving either the lower inner or lower outer quadrant triangles, which are a normal part of the standard Wise pattern, to a position over the tumor. This change must be accompanied by splitting the vertical limb of the reduction to accommodate the repositioning of the triangle, a technique known as split reduction.2 This alteration in the Wise pattern removes the skin directly over the tumor and guarantees that the anterior margin will be clear.
Intraoperative radiation therapy (IORT) is a technique used for administering a single dose of radiation therapy given during a ‘lumpectomy’ procedure. Two prospective, randomized trials have shown that, in selected low-risk patients, IORT may be adequate as the entire course of radiation therapy.3,4 In this video, we combined IORT with a split reduction tumor excision.