De‐Epithelialization Using Scalpel Versus Monopolar Electrocautery Cutting in Reduction Mammoplasty: A Prospective Comparative Study

ABSTRACT Background Reduction mammoplasty for symptomatic macromastia provides meaningful relief from musculoskeletal pain, postural strain, and functional limitations. A critical step in the procedure is pedicle de‐epithelialization, traditionally performed using a scalpel. Although effective, scalpel de‐epithelialization can be time‐intensive, prompting evaluation of alternative techniques such as monopolar electrocautery. Other sharp techniques include curved‐scissor de‐epithelialization, en bloc removal, and pedicle deskinning. Monopolar techniques utilize either a conventional blade electrode or a Colorado needle tip. This study compares surgical outcomes between scalpel and monopolar electrocautery de‐epithelialization. Methods A prospective, intra‐patient comparative study was conducted at the Department of Surgery, Alexandria Faculty of Medicine, between October 2023 and April 2025. Patients with symptomatic macromastia undergoing bilateral reduction mammoplasty received scalpel de‐epithelialization on the right breast and monopolar electrocautery on the left. Follow‐up assessments occurred at 1 week, 2 weeks, 1 month, and monthly thereafter for up to 12 months. The primary outcome was de‐epithelialization time. Secondary outcomes were intraoperative blood loss and pain both postoperatively and at 6 months. Statistical analyses included paired t ‐tests, Wilcoxon signed‐rank tests, and McNemar's tests. Results Sixty patients undergoing bilateral reduction mammoplasty were included. Monopolar electrocautery demonstrated a significantly shorter mean de‐epithelialization time compared to the scalpel (5.07 ± 0.88 minutes vs. 10.87 ± 1.93 minutes; p < 0.001). Intraoperative blood loss was also significantly lower with monopolar electrocautery (139.1 ± 20.64 mL vs. 176.7 ± 16.06 mL; p < 0.001). At 6 months, BREAST‐Q breast pain scores were modestly lower with the monopolar technique ( p = 0.046). Rates of postoperative complications and patient satisfaction were comparable between techniques. Conclusions Monopolar electrocautery significantly reduced de‐epithelialization time, the primary outcome of this study. It was also associated with lower intraoperative blood loss. Although modestly lower breast pain scores were observed at 6 months, the difference was small, and its clinical importance remains uncertain. The study was not powered to evaluate postoperative complication rates.