Complication Differences Between the Tumescent and Non-Tumescent Dissection Techniques for Mastectomy: A Meta-Analysis.

Yi Yang,Xinghua Qian,Jingying Feng,Fukun Sun,Juanying Zhu

doi:10.3389/fonc.2021.648955

Abstract

PurposeWe conducted a systematic literature search and pooled data from studies to compare the incidence of complications between the tumescent and non-tumescent techniques for mastectomy.MethodsWe searched PubMed, Embase, BioMed Central, Ovid, and CENTRAL databases for studies comparing the two mastectomy techniques up to November 1st, 2020. We used a random-effects model to calculate odds ratios (OR) with 95% confidence intervals (CI).ResultsNine studies were included with one randomized controlled trial (RCT). Meta-analysis indicated no statistically significant difference in the incidence of total skin necrosis (OR 1.18 95% CI 0.71, 1.98 I2 = 82% p=0.52), major skin necrosis (OR 1.58 95% CI 0.69, 3.62 I2 = 71% p=0.28), minor skin necrosis (OR 1.11 95% CI 0.43, 2.85 I2 = 72% p=0.83), hematoma (OR 1.19 95% CI 0.80, 1.79 I2 = 4% p=0.39), and infections (OR 0.87 95% CI 0.54, 1.40 I2 = 54% p=0.56) between tumescent and non-tumescent groups. Analysis of studies using immediate alloplastic reconstruction revealed no statistically significant difference in the incidence of explantation between the two groups (OR 0.78 95% CI 0.46, 1.34 I2 = 62% p=0.37). Multivariable-adjusted ORs on total skin necrosis were available from three studies. Pooled analysis indicated no statistically significant difference between tumescent and non-tumescent groups (OR 1.72 95% CI 0.72, 4.13 I2 = 87% p=0.23).ConclusionLow-quality evidence derived mostly from non-randomized studies is indicative of no difference in the incidence of skin necrosis, hematoma, seroma, infection, and explantation between the tumescent and non-tumescent techniques of mastectomy. There is a need for high-quality RCTs to further strengthen the evidence.

Highlights

Since the first description of the tumescent dissection mastectomy method by Worland [1] in 1996, the technique has gained popularity for both breast cancer and esthetic surgical procedures [2, 3]
Complication data per breast were available for all studies except for that by Gipponi et al [17], which reported data per patient
The authors reported a significantly higher incidence of minor skin necrosis in the tumescent group (2/15 patients) than in the non-tumescent group (7/15 patients) (p=0.45) without major skin necroses. They found no significant differences in the incidences of hematoma or wound infection between the two groups [17]

Summary

Introduction

Since the first description of the tumescent dissection mastectomy method by Worland [1] in 1996, the technique has gained popularity for both breast cancer and esthetic surgical procedures [2, 3]. Tumescent dissection involves an injection of a very dilute solution of local anesthetic with epinephrine and a crystalloid into the subcutaneous tissues of the breast [4] using multiple small stab punctures. The space created by the solution enhances visibility and ease of dissection, and allows the surgeon to distinguish between the subcutaneous and glandular tissues [5]. The epinephrine in the mixture causes vasoconstriction, which is further enhanced by the tamponading effect of the high volume infiltration on the subdermal vessels [7]. Another potential advantage is the analgesic effect offered by the local anesthetic which has been confirmed by researchers [8, 9]

Methods

Results

Conclusion