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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2011

01-10-2011 | American Society of Breast Surgeons

Additive Risk of Tumescent Technique in Patients Undergoing Mastectomy with Immediate Reconstruction

Authors: Akhil K. Seth, MD, Elliot M. Hirsch, MD, Neil A. Fine, MD, Gregory A. Dumanian, MD, Thomas A. Mustoe, MD, Robert D. Galiano, MD, Nora M. Hansen, MD, John Y. S. Kim, MD

Published in: Annals of Surgical Oncology | Issue 11/2011

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Abstract

Background

The potential advantages of tumescent mastectomy technique have been increasingly discussed within the literature. However, there is concern that tumescent solution may also affect postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy and immediate implant reconstruction.

Methods

Retrospective review of 897 consecutive patients (1,217 breasts) undergoing mastectomy with immediate implant reconstruction between 4/1998 and 10/2008 at a single institution was performed. Demographic and operative factors, postoperative outcomes, and overall follow-up were recorded. Complications were categorized by type and end-outcome. Fisher’s exact test, Student t-test, and multiple linear regression were used for statistical analysis.

Results

Tumescent (n = 332, 457 breasts) and nontumescent (n = 565, 760 breasts) patients were clinically similar. Mean follow-up was 36.5 months. Regression analysis demonstrated that tumescent technique increased the risk of overall complications [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.02–1.81, p = 0.04]. In particular, nonoperative and operative complications (OR 1.53, 95% CI 1.04–2.26, p = 0.04; OR 1.58, 95% CI 1.11–2.23, p = 0.01, respectively), and the rate of major mastectomy flap necrosis (OR 1.57, 95% CI 1.05-2.35, p = 0.03) were significantly affected. In patients with other, more significant risk factors, tumescent technique had an additive effect on complication rates. Additionally, the majority of tumescent breast complications (78.6%, 81/103) had at least one other significant risk factor.

Conclusions

Our review demonstrates that tumescent mastectomy with immediate implant reconstruction, although possessing distinct advantages, can increase postoperative complication rates. This additive effect is particularly apparent in patients with elevated complication risk at baseline. Choice of mastectomy technique should be made with careful consideration of patient comorbidities.
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Metadata
Title
Additive Risk of Tumescent Technique in Patients Undergoing Mastectomy with Immediate Reconstruction
Authors
Akhil K. Seth, MD
Elliot M. Hirsch, MD
Neil A. Fine, MD
Gregory A. Dumanian, MD
Thomas A. Mustoe, MD
Robert D. Galiano, MD
Nora M. Hansen, MD
John Y. S. Kim, MD
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1913-y

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