Tumescent mastectomy: the current indications and operative tips and tricks

Abstract

BackgroundTumescent mastectomy refers to usage of a mixture of lidocaine and epinephrine in a diluting saline solution that makes flaps firm and tense, thus minimizing systemic drugs toxicity and making surgery possible with minimal bleeding. This technique is very useful in elder women and those with American Society of Anesthesiologists; score III and IV. The objective was to establish an alternative safe technique to general anesthesia in some selected mastectomy patients.Patients and methodsTwenty candidate women for total mastectomy and axillary dissection were enrolled and consented to participate. After preparation, an anatomically directed infiltration was made under sedation, using a cocktail of lidocaine, bupivacaine, and epinephrine, followed after 20 minutes by the surgical incision and completion of mastectomy. All intraoperative and postoperative outcomes were recorded.ResultsAlthough 7 cases required added analgesic medications, no conversion for general anesthesia was recorded. Mean operative time was 81±15.8 minutes. Mean blood loss was 95.8±47.5 mL. There was no recorded intraoperative hemodynamic instability. Postoperative visual analog score was not exceeding 4 till the end of the first 24 hours. Opioids were not required in any case, and the mean dosage of Ketorolac used was 30±8.75 mg. Drains output and the incidence of postoperative complications were acceptable.ConclusionWe can consider tumescent mastectomy in well-selected patients a safe alternative for performing mastectomy when general anesthesia is hazardous, with minimal blood loss and long lasting postoperative analgesia without an additive effect on the operative time, hospital stay, and intraoperative and postoperative complications.

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

“…Various locoregional anesthetic techniques are also used for breast surgeries. These include local wound infiltration [ 30 ], tumescent anesthesia [ 31 ], regional anesthetic techniques, such as pectoral nerve (Pecs) blocks type 1 and 2 [ 32 , 33 ], serratus plane block (SPB) [ 34 ], and parasternal block (PSB) [ 35 ], pain pump [ 36 , 37 ], and intravenous regional block [ 7 , 38 ].…”

Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein

“…In 1987, Klein first infiltrated a large number of diluted adrenaline-containing lidocaine solution into the subcutaneous fat layer for local fat aspiration anesthesia, namely swelling anesthesia. [ 20 , 21 ] Due to its safety, less blood loss, less tissue damage, prolonged anesthesia time, and good analgesic effect, it has been widely used in various plastic operations ever since. [ 19 ] Comparatively, patients in maxillofacial surgery and plastic surgery often have higher requirements for reducing pain and maintaining beauty.…”

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction.

“…Various locoregional anesthetic techniques are also used for breast surgeries. These include local wound infiltration, 30 tumescent anesthesia, 31 regional anesthetic techniques, such as pectoralis nerve (Pecs) blocks type 1 and 2, 32,33 serratus plane block (SPB), 34 and parasternal block (PSB), 35 pain pump, 36,37 and intravenous regional block. 38,39 Locoregional anaesthesia provides effective anesthesia and analgesia in the perioperative setting.…”