Tumescence and sharp versus electrocautery dissection in minimal access mastectomy: a real-world retrospective cohort study

<h2>Abstract</h2><h3>Background</h3> Tumescence and sharp or electrocautery techniques have been employed during skin flap development in minimal access nipple-sparing mastectomy (NSM) with immediate prosthesis breast reconstruction. Our study evaluated the impact of techniques on complications after this surgery. <h3>Methods</h3> In this real-world retrospective cohort study, 5436 individuals undergoing NSM from 12 centers in China were identified. After exclusions and propensity score matching (PSM), a total of 1252 female breast cancer patients who underwent minimal access NSM with immediate prosthesis breast reconstruction between January 2016 and December 2022 were included. The effect of surgical techniques on the perioperative outcomes and postoperative complications was investigated using logistic regression analysis. The level of significance was set at P< .05. <h3>Findings</h3> After PSM, we found that patients in the tumescence and sharp dissection group (n=313) experienced significantly lower rates of necrotic complications (5.8% vs 13.0%; P=.001), infection (2.6% vs 5.6%; P=.041), implant loss (0.3% vs 2.2%; P=.025), and had shorter mean operation time (median [IQR] min, 177.0 [132.0-219.0] min, and 201.0 [143.0-249.0] min; P< .001), compared with those in the electrocautery dissection group (n=939). <h3>Interpretation</h3> Tumescence and sharp dissection might be a better option in skip flap development during minimal access NSM with immediate prosthesis breast reconstruction, in regard to operation time and surgical complications. A limitation is the variation in surgeons' skills across multiple centers. <h3>Funding</h3> National Key Research and Development Program of China (2023YFC3404500), the Natural Science Foundation of China (92057210, 82125017, 82173064, 92359302, 82322030), Science and Technology Program of Guangzhou (202103000070, 202201020479), and the New Cornerstone Science Foundation through the New Cornerstone Investigator Program and the XPLORER PRIZE.