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The Impact of Tumescent Technique on Outcomes of Autologous Breast Reconstruction
Christina R Vargas1; Pieter G Koolen1; Joseph A Ricci1; Bernard T Lee1
1Beth Israel Deaconess Medical Center / Harvard Medical School, Boston, MA

Background: Use of the tumescent dissection technique during mastectomy has been reported to facilitate development of a hydrodissection plane, shorten operating time, reduce blood loss, and provide additional analgesia. Other studies suggest that tumescent dissection has a negative impact on post-operative complications following immediate implant placement, however, the effect on autologous reconstruction has not been established.

Methods: A retrospective review was conducted of all immediate autologous breast reconstruction procedures at a single academic center between January 2004 and December 2013. Patient records were queried for age, BMI, diabetes, active smoking, pre-reconstruction radiation therapy, mastectomy weight, and tumescent technique during mastectomy. All post-operative occurrences of breast hematoma, seroma, and mastectomy skin necrosis were noted.

Results: A total of 698 immediate autologous post-mastectomy breast reconstruction flaps were performed during the study period; mean patient age was 49.38.3 years and average mastectomy weight was 769.3413 grams. 49.2% of the mastectomies were performed using the tumescent dissection technique. Univariate analysis revealed no significant difference in the incidence of breast hematoma (p=0.779), seroma (p=0.180), or mastectomy skin necrosis (p=0.688) in patients undergoing tumescent dissection during mastectomy. Multivariate analysis, adjusted for clustering related to bilateral reconstruction, also demonstrated no significant association between the use of tumescent technique and post-operative breast hematoma (p=0.978), seroma (p=0.340), or mastectomy skin necrosis (p=0.759).

Conclusion: Use of the tumescent dissection technique during mastectomy is not significantly associated with adverse outcomes following autologous breast reconstruction. Despite concern for its impact on implant reconstruction, our findings suggest that this method can be used safely preceding autologous procedures.

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