A comparison between electrocautery and scalpel plus scissor in breast conserving surgery

Breast conserving therapy (BCT) was originally developed to achieve the same survival outcome as mastectomy while improving the quality of life. In fact, this approach resulted in high local control rates, but 30% of patients treated with BCT using electrocautery had a fair or poor cosmetic result at the 3-year follow-up. In 106 patients with stage I and II breast cancer treated by wide excision and axillary dissection using scalpel plus scissor or electrocautery followed by radiation therapy, the histological damage and cosmetic results were analyzed. The duration of operation in the scalpel plus scissor group was shorter than that in the electrocautery group, although blood loss was greater. The electrocautery caused extensive histological tissue damage to the stump compared with the scalpel plus scissor group. The cell death by TUNEL method was significantly increased on electrocautery groups. In addition, although the global cosmetic result of the electrocautery group was similar to that of the scalpel plus scissor group after surgery, the scalpel plus scissor group had a much better cosmetic outcome after surgery and radiation therapy at the 3-year follow-up. Clinical tumor size T1 and pathological tumor size over 2 cm were factors that negatively affected the cosmetic score after surgery in each group. Scalpel plus scissor in breast conserving surgery has less tissue damage and better cosmetic results at the 3-year follow-up.