C. R. Vargas1, P. G. Koolen1, J. A. Ricci1, B. T. Lee1 1Beth Israel Deaconess Medical Center,Surgery / Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction:
Use of the tumescent dissection technique during mastectomy has been reported to facilitate development of a hydrodissection plane, to shorten operating time, to reduce operative blood loss, and to provide additional local anesthesia. Despite these advantages, the impact of this technique on post-operative outcomes remains unclear. Several prior studies have suggested that tumescent dissection has a negative impact on post-operative complications following immediate implant placement, however, the effect on autologous reconstruction has not been clearly established.
Methods:
A retrospective review was conducted, using a prospectively maintained database, of all immediate autologous breast reconstruction procedures performed at a single academic center between January 2004 and December 2013. Electronic patient records were queried for age, BMI, diabetes, active smoking, pre-reconstruction radiation therapy, mastectomy weight, and tumescent technique during mastectomy. Mastectomy weight was divided into quartiles for improved clinical interpretation. All post-operative occurrences of breast hematoma, seroma, and mastectomy skin necrosis were also collected.
Results:
A total of 698 immediate autologous post-mastectomy breast reconstruction flaps were performed during the study period; mean patient age was 49.3±8.3 years and average mastectomy weight was 769.3±413 grams. 49.2% of the mastectomies were performed using the tumescent dissection technique. Univariate analysis revealed no significant difference in the incidence of breast hematoma (p=0.779), seroma (p=0.180), or mastectomy skin necrosis (p=0.688) in patients who underwent tumescent dissection during mastectomy. Multivariate analysis, adjusted for clustering related to bilateral reconstruction, also demonstrated no significant association between the use of tumescent technique and post-operative breast hematoma (p=0.978), seroma (p=0.340), or mastectomy skin necrosis (p=0.759) after covariate adjustment.
Conclusion:
Use of the tumescent dissection technique during mastectomy is not significantly associated with adverse outcomes following autologous breast reconstruction. Despite concern for its impact on implant reconstruction, our findings suggest that the tumescent method can be used safely in conjunction with autologous procedures.