Although electrocautery is popularly used for the skin flap preparations at the time of mastectomy, we have been making the skin flap using the tumescent technique for the protects of the wound and skin flap since 2012 in our department. The aim of the study is to examine the differences of the clinical outcomes by between the surgeons (specialist who is familiar with breast surgery vs non-special surgeons).
166 patients who underwent the reconstruction after 1ststage of mastectomy with the tumescent technique at our hospital from March 2012 to December 2018 were enrolled. Tumescent technique; just before skin incision, we injected the tumescent solusions (200ml of physiological saline, 1mg of adrenaline, 20ml of xylocaine) subcutaneously into the breast and we started the sharp skin incision containing the tumor and around the areola like the spindle shape. If the tumor is close to the skin, we resected the skin just above tumor. We separated between subcutaneous and mammary tissue, and made the skin flap widely using the mechenbaum scissor and the wound retractor for protect the skin cutting edge. The most important things of this technique are to get the viewing field using the wound retractor with light and and the hemostasis exactly using McCannd forceps.
patients characteristics is mean age 47.9 years (25-73 years), BMI is mean 21.1 (16.4-35.4), complication disease are 4 cases of hypertension, 4 cases of diabetes mellitus, 3 cases of radiotherapy previously, we performed surgery for 52 cases of DICS, for 114 cases of the invasive cancer including 10 cases of the axillary lymph node dissections, specialist performed 100 cases of mastectomy, on the other hand non-special surgeons performed 66 cases of mastectomy. Mean operation time is 56 min and 62 min (p = 0.314), there are no significant differences between the weight of the resected tissue and operation time (p = 0.062. Mean blood loss is 54ml each. 49 case (29%) of the mild necrosis of the skin, and 8 cases (4.7%) of hematoma were totally occurred after surgery, There are also no significant differences between specialist and non-special surgeons.
Mastectomy using the tumescent technique is easy and safe for not only specialist but also non-special surgeons.
Clinical trial identification
Tissue expander and Inplants were approved for clinical use in Japan in July 2013.Since 2013, the reconstruction after mastectomy has been increasing year by year in Japan.
Legal entity responsible for the study
Has not received any funding.
The author has declared no conflicts of interest.