Clinical scienceUse of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis following immediate breast reconstruction
Section snippets
Methods
A retrospective medical record review was performed of 275 consecutive patients who underwent mastectomy with immediate breast reconstruction by 3 plastic surgeons at the Brigham and Women's Hospital and Faulkner Hospital between 2002 and 2008. The study methods and design were reviewed and approved by the institutional review board of Brigham and Women's Hospital/Faulkner Hospital. A total of 380 consecutive mastectomies with immediate breast reconstructions were performed during the 6-year
Results
A total of 275 consecutive patients underwent 170 unilateral and 105 bilateral mastectomies with immediate reconstruction, totaling 380 reconstructions during the 6-year period. Of these, 100 mastectomies were performed using the tumescent technique and 280 were performed without using the tumescent technique. There was no significant difference in patient characteristics between the tumescent mastectomy group and the nontumescent mastectomy group, including age, BMI, comorbidities, smoking
Comments
Use of the tumescent technique has been reported as advantageous in mastectomies for several reasons. Hydrodissection and overdistension with the tumescent fluid may provide tension within the breast to facilitate easier skin flap dissection while decreasing the need for electrocautery. Some surgeons believe that minimal use of electrocautery during mastectomy is important to avoid potential thermal injury to the skin flaps, which can lead in turn to necrosis, especially when the mastectomy
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The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction
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2023, Surgical Clinics of North AmericaCitation Excerpt :The reported rates of skin necrosis after mastectomy with or without reconstruction vary considerably (5%–30%) owing to heterogeneity in defining necrosis, especially in minor cases.35,36 Risk factors for skin flap necrosis after mastectomy include older age, obesity, large breasts, hypertension, active smoking, sarcopenia, prior radiation treatment, incision placement, and tissue expander volume.36–38 Skin-sparing mastectomies are not associated with an increased risk of skin necrosis compared with conventional flat mastectomy.
Evaluation of tumescent local anesthesia in cats undergoing unilateral mastectomy
2021, Veterinary Anaesthesia and AnalgesiaTumescent technique versus electrocautery mastectomy: A randomized controlled trial
2020, Surgical OncologyCitation Excerpt :The one study [15] which only included one type of reconstruction (skin-sparing mastectomies with immediate autologous micro-surgical reconstruction) was the only study to find a lower rate of flap necrosis in the tumescent group, although not significant (12.8% vs. 14.0%, p = 0.646). Two of the studies included in the meta-analysis [10,11] showed that advanced age, obesity, history of radiation and smoking also increased the risk of flap necrosis. Seth et al. noted that the majority of patients having tumescent breast complications had at least one other risk factor suggesting that other, more significant, preoperative risk factors contribute to the risk of developing complications.
The Skin Necrosis Conundrum: Examining Long-term Outcomes and Risk Factors in Implant-Based Breast Reconstruction
2023, Aesthetic Surgery Journal
The first 2 authors contributed to this project equally.