Tumescent Technique Does Not Increase the Risk of Complication Following Mastectomy with Immediate Reconstruction

• Published in: Annals of surgical oncology Vol. 21; no. 2; pp. 384 - 388
• Main Authors: Khavanin, Nima, Fine, Neil A., Bethke, Kevin P., Mlodinow, Alexei S., Khan, Seema A., Jeruss, Jacqueline S., Hansen, Nora M., Kim, John Y. S.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2014; Springer Nature B.V
• Subjects: Anesthetics, Local - administration & dosage; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Chicago - epidemiology; Female; Follow-Up Studies; Graft Survival; Humans; Longitudinal Studies; Mammaplasty; Mastectomy - methods; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Postoperative Complications - epidemiology; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgical Flaps; Surgical Oncology; Treatment Outcome; Chicago; Postoperative Complication Rate; Postmastectomy Radiation; Prosthetic Reconstruction; Acellular Dermal Matrix; Flap Necrosis
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-013-3311-0

Background Despite the growing interest in the advantages of tumescent mastectomy technique, there remain concerns that tumescent solution may increase postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy in the setting of immediate prosthetic reconstruction. Methods Retrospective review of 1,491 breasts (1,030 patients) treated by 4 oncologic and 2 reconstructive surgeons between 2004 and 2012 at a single institution. The primary outcomes of interest included seroma, hematoma, infection, and mastectomy flap necrosis, as well as conversion to autologous reconstruction. Multiple logistic regression was used to determine the adjusted influence of tumescence on outcomes. Results The tumescent cohort ( n  = 890 breasts) was younger and experienced lower rates of preoperative radiation than the nontumescent cohort ( n  = 601 breasts). Mean follow-up was 21.2 months. While tumescent procedures were on average 20 min faster, postoperative complication rates did not significantly differ between cohorts. Regression analysis controlling for potential confounders, including differences in surgeon technique, failed to identify tumescent mastectomy as an independent risk factor for complication [odds ratio (OR) = 1.2, 95 % confidence interval (CI) = 0.8–1.8, p  = 0.385]. Individually, neither seroma, hematoma, infection, nor flap necrosis was affected significantly by the use of tumescence (OR = 1.66, 95 % CI = 0.73–3.78, p  = 0.229; OR = 1.11, 95 % CI = 0.42–2.95, p  = 0.837; OR = 0.84, 95 % CI = 0.4–1.75, p  = 0.689; OR = 1.19, 95 % CI = 0.7–2.03, p  = 0.67, respectively). Discussion This longitudinal study is well equipped to assess the influence of tumescent mastectomy technique in the hands of experienced and high-volume oncologic surgeons on postoperative outcomes. Our analysis suggests that in the setting of an immediate prosthetic reconstruction, tumescent mastectomy does not independently affect postoperative complication rates.