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Annals of Surgical Oncology

, 18:3041 | Cite as

Additive Risk of Tumescent Technique in Patients Undergoing Mastectomy with Immediate Reconstruction

  • Akhil K. Seth
  • Elliot M. Hirsch
  • Neil A. Fine
  • Gregory A. Dumanian
  • Thomas A. Mustoe
  • Robert D. Galiano
  • Nora M. Hansen
  • John Y. S. Kim
American Society of Breast Surgeons

Abstract

Background

The potential advantages of tumescent mastectomy technique have been increasingly discussed within the literature. However, there is concern that tumescent solution may also affect postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy and immediate implant reconstruction.

Methods

Retrospective review of 897 consecutive patients (1,217 breasts) undergoing mastectomy with immediate implant reconstruction between 4/1998 and 10/2008 at a single institution was performed. Demographic and operative factors, postoperative outcomes, and overall follow-up were recorded. Complications were categorized by type and end-outcome. Fisher’s exact test, Student t-test, and multiple linear regression were used for statistical analysis.

Results

Tumescent (n = 332, 457 breasts) and nontumescent (n = 565, 760 breasts) patients were clinically similar. Mean follow-up was 36.5 months. Regression analysis demonstrated that tumescent technique increased the risk of overall complications [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.02–1.81, p = 0.04]. In particular, nonoperative and operative complications (OR 1.53, 95% CI 1.04–2.26, p = 0.04; OR 1.58, 95% CI 1.11–2.23, p = 0.01, respectively), and the rate of major mastectomy flap necrosis (OR 1.57, 95% CI 1.05-2.35, p = 0.03) were significantly affected. In patients with other, more significant risk factors, tumescent technique had an additive effect on complication rates. Additionally, the majority of tumescent breast complications (78.6%, 81/103) had at least one other significant risk factor.

Conclusions

Our review demonstrates that tumescent mastectomy with immediate implant reconstruction, although possessing distinct advantages, can increase postoperative complication rates. This additive effect is particularly apparent in patients with elevated complication risk at baseline. Choice of mastectomy technique should be made with careful consideration of patient comorbidities.

Keywords

Postoperative Complication Rate Flap Necrosis Preoperative Risk Factor Postoperative Hematoma Complication Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

We have no commercial interests or financial support to disclose.

References

  1. 1.
    Pinsolle V, Grinfeder C, Mathoulin-Pelissier S, Faucher A. Complication analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg. 2006;59:1017–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Davies K, Allan L, Roblin P, Ross D, Farhadi J. Factors affecting post-operative complications following skin-sparing mastectomy with immediate breast reconstruction. Breast. 2011;20:21–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Berry T, Brooks S, Sydow N, Djohan R, Nutter B, Lyons J, et al. Complication rates of radiation on tissue expander and autologous breast reconstruction. Ann Surg Oncol. 2010;17:S202–10.CrossRefGoogle Scholar
  4. 4.
    Worland RG. Expanded utilization of the tumescent technique for mastectomy. Plast Reconstr Surg. 1996;98:1321.PubMedGoogle Scholar
  5. 5.
    Staradub VL, Morrow M. Modified radical mastectomy with knife technique. Arch Surg. 2002;137:105–10.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Donoghue JM, Chaubal ND, Haywood RM, Rickard R, Desai SN. An infiltration technique for reduction mammaplasty: results in 192 consecutive breasts. Acta Chir Plast. 1999; 41:103–6.PubMedGoogle Scholar
  7. 7.
    Soueid A, Nawinne M, Khan H. Randomized clinical trial on the effects of the use of diluted adrenaline solution in reduction mammaplasty: same patient, same technique, same surgeon. Plast Reconstr Surg. 2008;121:30e–33e.PubMedCrossRefGoogle Scholar
  8. 8.
    Rosaeg OP, Bell M, Cicutti NJ, Dennehy KC, Lui ACP, Krepski B. Pre-incision infiltration with lidocaine reduces pain and opioid consumption after reduction mammoplasty. Reg Anesth Pain Med. 1998; 23:575–9.PubMedGoogle Scholar
  9. 9.
    Armour AD, Rotenberg BW, Brown MH. A comparison of two methods of infiltration in breast reduction surgery. Plast Reconstr Surg. 2001;108:343–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Metaxotos NG, Asplund O, Hayes M. The efficacy of bupivicaine with adrenaline in reducing pain and bleeding associated with breast reduction: a prospective trial. Br J Plast Surg. 1999;52:290–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Habbema L. Breast reduction using liposuction with tumescent local anesthesia and powered cannulas. Dermatol Surg. 2008;35:41–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Jabs D, Richards BG, Richards FD. Quantitative effects of tumescent infiltration and bupivicaine injection in decreasing postoperative pain in submuscular breast augmentation. Aesthetic Surg J. 2008; 28:528–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Paige KT, Bostwick III J, Bried JT. TRAM flap breast reconstruction: tumescent technique reduces blood loss and transfusion requirement. Plast Reconstr Surg. 2004;113:1645–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Carlson GW. Total mastectomy under local anesthesia: the tumescent technique. Breast J. 2005;11:100–2.PubMedCrossRefGoogle Scholar
  15. 15.
    Shoher A, Hekier R, Lucci Jr A. Mastectomy performed with scissors following tumescent solution injection. J Surg Oncol. 2003;83:191–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Boni R. Tumescent power liposuction in the treatment of the enlarged male breast. Dermatology. 2006;213:140–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Porter K, O’Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176:8–11.PubMedCrossRefGoogle Scholar
  18. 18.
    Miller E, Paull DE, Morrissey K, Cortese A, Nowak E. Scalpel versus electrocautery in modified radical mastectomy. Am Surg. 1988;54:284–6.PubMedGoogle Scholar
  19. 19.
    Kurtz S, Frost D. A comparison of two surgical techniques for performing mastectomy. Eur J Surg Oncol. 1995;21:143–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Chun YS, Verma K, Rosen H, et al. Use of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis following immediate breast reconstruction. Am J Surg. 2011;201:160–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Black D, Golshan M, Christian R, et al. Post-operative outcomes of mastectomy with breast tumescence infiltration. Presented at: 29th San Antonio Breast Conference; December 2006.Google Scholar
  22. 22.
    Larson DL, Basir Z, Bruce T. Is oncologic safety compatible with a predictably viable mastectomy skin flap? Plast Reconstr Surg. 2011; 127:27–33.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Akhil K. Seth
    • 1
  • Elliot M. Hirsch
    • 1
  • Neil A. Fine
    • 1
  • Gregory A. Dumanian
    • 1
  • Thomas A. Mustoe
    • 1
  • Robert D. Galiano
    • 1
  • Nora M. Hansen
    • 2
  • John Y. S. Kim
    • 1
  1. 1.Division of Plastic SurgeryNorthwestern Memorial HospitalChicagoUSA
  2. 2.Lynn Sage Comprehensive Breast CenterFeinberg School of Medicine, Northwestern UniversityChicagoUSA

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