PURPOSE: Tumescent injection is commonly used in subcutaneous surgery, such as massive weight loss procedures, and it is used routinely in liposuction and facial surgery. Tumescent injection is seldom used in reduction mammaplasty, because of an intuitive sense that the added fluid volume could distort the shape or interfere with the resection. Our clinical experience in using this technique in over 700 breast reductions has not confirmed these speculative fears. The present study was undertaken to quantitate several changes associated with tumescent injection, including the weight of the pathology specimen, blood loss, operative time, tissue resection, shape, symmetry, and complications
METHODS: Fifty consecutive patients were studied according to protocol, using a single method of reduction mammaplasty, which was performed by a single surgeon (BC). One breast was not injected. The study breast was injected with an average of 750 cc of LR solution, which contained a mixture of 0.05% lidocaine and 1:500,000 epinephrine. The solution contributed to local pain relief, so that anesthesia was achieved with an LMA tube and minimal to deep propofol sedation. Breast resection was done with cautery and knife dissection. Intraoperative measurements included: time for resection, time for hemostasis, blood loss, and pathological specimen weight. The postoperative shape and symmetry were judged and scored by a group of independent observers, who were blinded to the experimental versus control side. Patients were observed over a 9 month period for post-operative complications.
RESULTS:
There was a total timesaving of 19 minutes and 20 seconds in the injected breasts (SEM 0.061; p<0.001). Blood loss in the injected breast was 370 cc less than the control side (SEM 37.0; p<0.001). There were no differences in the aesthetic outcome or symmetry between the two breasts. There were 7 similar complications in 5 patients with no statistical difference between the injected and non-injected breasts. The pathological specimen weight was increased by 12% in the injected breast (190 grams of the 1,547 gram mean reduction weight). The cost of injection materials was $3.67 for each breast.
CONCLUSION:
Tumescent injection is a positive addition to the reduction mammaplasty procedure. Safety is enhanced by the by the propofol sedation, the remarkable reduction in blood loss, and the 50% reduction in time for resection and hemostasis. There were no adverse effects on shape or symmetry, and the complications were comparable. Operating in a bloodless field saved time and energy for the surgeons. The 12% increase in measured resection volume was consistent and predictable, which enables surgeons to ethically report a known difference in injected breast weight to third party carriers. This study suggests that tumescent injection is safe and effective for routine use in breast reduction.