The Use of Hydrodissection in Nipple- and Skin-sparing Mastectomy: A Retrospective Cohort Study

Tasoulis, Marios Konstantinos; Agusti, Ana; Karakatsanis, Andreas; Montgomery, Catherine; Marshall, Chris; Gui, Gerald

doi:10.1097/gox.0000000000002495

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…Figure 1 shows the PRISMA flow-chart. We included nine studies in the review (15)(16)(17)(18)(19)(20)(21)(22)(23). Table 1 presents their characteristics.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Figure 1 shows the PRISMA flow-chart. We included nine studies in the review (15)(16)(17)(18)(19)(20)(21)(22)(23). Table 1 presents their characteristics.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…This technique is considered to provide more even mastectomy flaps, potentially associated with lower autologous fat transfer rates. These early results should be interpreted with caution as our previous experience with hydrodissection was assessed in sub-pectoral IBR (15). Alternatives techniques to improve the upper pole aesthetics and potentially decrease visibility of the implant contour and rippling have also been described, using anterior implant cover with ADM and a "slip" of the pectoralis muscle for additional superior coverage (12).…”

Section: Discussionmentioning

confidence: 99%

“…All mastectomies and reconstructions were performed using a uniform technique by, or under the direct supervision of, the senior author (GG). A skin or nipple sparing mastectomy was performed using the hydrodissection technique and scissors as previously described (15). A bovine ADM was used to hold the implant in position and create the pre-pectoral pocket.…”

Section: Surgical Technique-implant and Adm Reconstructionmentioning

confidence: 99%

Pre-pectoral one-stage breast reconstruction with anterior biological acellular dermal matrix coverage

Khan¹,

Tasoulis²,

Teoh³

et al. 2021

Gland Surg

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Background: Pre-pectoral implant breast reconstruction (IBR) is gaining popularity. Several techniques using different types of meshes and methods of placement have been described, but no method is currently considered standard. The aim of this study was to evaluate the outcomes of pre-pectoral IBR using acellular dermal matrix (ADM) for anterior implant cover. Methods: Retrospective cohort study of consecutive patients who underwent pre-pectoral IBR between November 2016 to August 2018. Data on demographics, adjuvant therapies and operative technique was collected. Postoperative complications, length of hospital stay and secondary cosmetic procedures were recorded. Statistical analysis was performed using descriptive statistics, non-parametric tests and logistic regression. Results: One hundred and eleven pre-pectoral IBR were performed in 65 patients. Median age was 41 [interquartile range (IQR), 35-51.5] years, and BMI 22 (IQR, 20.4-24.4) kg/m 2 . Therapeutic mastectomy was performed in 33 procedures with nipples preservation in 78 cases. The median mastectomy weight and implant volume was 360 (IQR, 220-533) gr, and 445 (IQR, 400-475) cc respectively. At a median followup of 18 (IQR, 12-22.5) months, 37 mastectomies had at least 1 complication, but only 12 required surgery.The implant loss rate was 4.5% (5 cases). Lipofilling as secondary procedure was performed in 10.8% of cases. Factors associated with post-operative complications on univariate analysis were nipple preservation (P=0.028), BMI (P=0.01) and implant volume (P=0.027) but these did not remain significant on multivariate analysis.Conclusions: Pre-pectoral IBR using ADM for anterior implant cover is associated with low complication and reconstructive failure rate. Patient selection and meticulous surgical technique are important for successful outcome.

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“…Reduction in operative bleeding and decreased operative time was also reported. 29,30 Henn and colleagues reported a statistically significant decrease in operative blood loss during vaginal prolapse surgery using vasoconstrictors without significant cardiovascular changes. 21 Our findings support those results.…”

Section: Discussionmentioning

confidence: 99%

The role of hydrodissection in native tissue repair of anterior vaginal wall defects

Schwarzman

Samueli

Shaco-Levy

et al. 2021

Aust NZ J Obst Gynaeco

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A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). Materials:Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ 2 and Fisher's exact tests.Results: Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). Conclusions:After hydrodissection, less bleeding was noted without compromise the surgical planes.

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The Use of Hydrodissection in Nipple- and Skin-sparing Mastectomy: A Retrospective Cohort Study

Cited by 12 publications

References 19 publications

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

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

Pre-pectoral one-stage breast reconstruction with anterior biological acellular dermal matrix coverage

The role of hydrodissection in native tissue repair of anterior vaginal wall defects

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