Journal Article

Switching to Tumescent Dissection in Mastectomy

Bakillah, Emna, Adekeye, Seye, Brooks, Ari D.

2025

Overview

Introduction: Tumescent dissection (TUM) combines the use of crystalloid, local anesthetic, and epinephrine to create a bloodless plane to raise skin flaps. We aim to compare outcomes of TUM versus standard electrocautery dissection in mastectomies with and without reconstruction. Methods: We conducted a retrospective cohort study of patients who underwent mastectomy by a single surgeon between January 2016 and October 2020 utilizing the electronic medical record. The primary outcome was complication rate, and the secondary outcome was operative time. Chi‐squared analysis and two‐sample t ‐tests were used to examine outcomes. Results: Among 242 patients, 141 patients underwent TUM and 101 patients underwent electrocautery. 44.68% of TUM patients experienced one or more complications compared to 59.41% of electrocautery patients ( p = 0.024). There were fewer cases of wound healing complications in the TUM group with reconstruction compared to the electrocautery group with reconstruction (6.1% vs. 21%, p = 0.005). Infection rate was higher in the TUM group with reconstruction compared to the electrocautery group with reconstruction (14.3% vs. 3.2%, p = 0.023). There was no significant difference in rates of hematoma, seroma, skin flap necrosis, nipple areolar complex necrosis, or re‐exploration by dissection technique. The mean operative time was shorter with TUM compared to electrocautery (216.09 min vs. 250.16 min, p = 0.016). Conclusion: TUM yields comparable results with decreased overall complication rates compared to electrocautery dissection. Electrocautery thermal effect may account for skin‐related complications. Additionally, tumescent mastectomies have shorter length of operative time which could reduce the risk of complications associated with increased time under general anesthesia.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Adult / Aged / Anesthesia / Anesthetics, Local - administration & dosage / Breast cancer / Breast Neoplasms - surgery / Chemotherapy / Chi-square test / Disease prevention / Dissection / Dissection - adverse effects / Dissection - methods / Electrocoagulation - adverse effects / Electrocoagulation - methods / Electronic health records / Electronic medical records / Epinephrine - administration & dosage / Ethnicity / Female / Hematoma / Humans / Infections / Mammaplasty - methods / Mastectomy / Mastectomy - adverse effects / Mastectomy - methods / Medical records / Middle Aged / Necrosis / Operative Time / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Reconstruction / Retrospective Studies / Skin / Surgeons / Surgical Flaps / Temperature effects / Wound healing