Switching to Tumescent Dissection in Mastectomy

Area of Science:

• Surgical Oncology
• Plastic and Reconstructive Surgery

Background:

• Mastectomy techniques aim to minimize complications and operative time.
• Tumescent dissection (TUM) utilizes local anesthesia and epinephrine for flap elevation.
• Electrocautery is a standard method for tissue dissection during surgery.

Purpose of the Study:

• To compare the complication rates and operative times of tumescent dissection versus standard electrocautery dissection in mastectomy procedures.
• To evaluate outcomes in both mastectomies with and without immediate reconstruction.

Main Methods:

• Retrospective cohort study of 242 patients undergoing mastectomy between January 2016 and October 2020.
• Comparison of complication rates (primary outcome) and operative time (secondary outcome) between TUM and electrocautery groups.
• Statistical analysis using Chi-squared tests and two-sample t-tests.

Main Results:

• TUM group (141 patients) had a lower overall complication rate (44.68%) compared to electrocautery (101 patients, 59.41%; p=0.024).
• Wound healing complications were reduced with TUM in reconstructed cases (6.1% vs. 21%; p=0.005), but infection rates were higher (14.3% vs. 3.2%; p=0.023).
• Mean operative time was significantly shorter for TUM (216.09 min) versus electrocautery (250.16 min; p=0.016).

Conclusions:

• Tumescent dissection offers comparable outcomes to electrocautery in mastectomies with reduced overall complication rates.
• Electrocautery's thermal effect may contribute to skin-related complications, which appear reduced with TUM.
• Shorter operative times with TUM may decrease risks associated with prolonged general anesthesia.