Total mastectomy under local anesthesia: the tumescent technique

Area of Science:

• Oncology
• Anesthesiology
• Surgical Techniques

Background:

• Management of breast cancer in elderly women is complex due to comorbidities and less aggressive tumor biology.
• Older patients are often undertreated, increasing risks associated with cancer recurrence.
• Estrogen receptor (ER)-negative tumors and treatment resistance pose challenges in this demographic.

Purpose of the Study:

• To evaluate the safety and efficacy of the tumescent technique for total mastectomy in elderly patients.
• To assess the feasibility of performing mastectomies under local anesthesia in high-risk patients.
• To determine the perioperative outcomes and patient recovery following tumescent mastectomy.

Main Methods:

• Four elderly patients (mean age 72) with breast cancer underwent unilateral total mastectomy.
• The tumescent technique involved local anesthesia with dilute lidocaine and epinephrine infusion.
• Patients were American Society of Anesthesiologists (ASA) class IV, indicating significant health risks.

Main Results:

• No surgical morbidity (hematoma, infection, necrosis) was observed.
• All patients experienced adequate anesthesia and were discharged within 1-4 days.
• Mean operative time was 35 minutes, with no deviations from the tumescent technique.

Conclusions:

• The tumescent technique is a safe and effective alternative for total mastectomy in elderly patients.
• This method is particularly suitable for patients who are poor candidates for general anesthesia.
• The procedure demonstrated good outcomes with minimal complications in this high-risk cohort.