The Value of Tumescent Infiltration in Bilateral Breast Reduction: Optimizing Vasoconstriction

Surgical adjuncts should improve surgical outcomes but should not increase complications. Epinephrine reduces bleeding in breast reduction, but various doses and volumes have been used. The ideal dose of epinephrine is still debated. The aim of this study was to assess blood loss after infiltration of 1 L of tumescent fluid containing epinephrine at a concentration of 1 in 100,000 (1 in 10⁵) and 1200 mg of lignocaine in patients undergoing bilateral breast reduction.

Thirty-three consecutive patients undergoing bilateral breast reduction were included in the study. Data captured included age, mass of tissue removed, volume of blood loss, and surgical complications, especially hematoma formation.

The mean age was 41 years (range, 17-74 years). The mean mass of tissue removed was 786 g (range, 307-1339 g). The mean total blood loss was 76 mL (range, 50-200 mL)-that is, 38 mL per side. One patient presented with a unilateral swelling and pain after 48 hours and underwent exploration. A venous pool of <100 mL of blood was evacuated. One patient suffered bilateral nipple loss of >50%, and another patient suffered loss of 30%. The mean follow-up is 9 months (range, 2-20).

One liter of Ringer's lactate containing epinephrine at a concentration of 1 in 10⁵, when injected into the breasts (500 mL per breast) before breast reduction, results in a massive reduction in blood loss.