title: Additive risk of tumescent technique in patients undergoing mastectomy with immediate reconstruction.
abstract: BACKGROUND
  The potential advantages of tumescent mastectomy technique have been increasingly discussed within the literature. However, there is concern that tumescent solution may also affect postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy and immediate implant reconstruction.
  
  
  METHODS
  Retrospective review of 897 consecutive patients (1,217 breasts) undergoing mastectomy with immediate implant reconstruction between 4/1998 and 10/2008 at a single institution was performed. Demographic and operative factors, postoperative outcomes, and overall follow-up were recorded. Complications were categorized by type and end-outcome. Fisher's exact test, Student t-test, and multiple linear regression were used for statistical analysis.
  
  
  RESULTS
  Tumescent (n = 332, 457 breasts) and nontumescent (n = 565, 760 breasts) patients were clinically similar. Mean follow-up was 36.5 months. Regression analysis demonstrated that tumescent technique increased the risk of overall complications [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.02-1.81, p = 0.04]. In particular, nonoperative and operative complications (OR 1.53, 95% CI 1.04-2.26, p = 0.04; OR 1.58, 95% CI 1.11-2.23, p = 0.01, respectively), and the rate of major mastectomy flap necrosis (OR 1.57, 95% CI 1.05-2.35, p = 0.03) were significantly affected. In patients with other, more significant risk factors, tumescent technique had an additive effect on complication rates. Additionally, the majority of tumescent breast complications (78.6%, 81/103) had at least one other significant risk factor.
  
  
  CONCLUSIONS
  Our review demonstrates that tumescent mastectomy with immediate implant reconstruction, although possessing distinct advantages, can increase postoperative complication rates. This additive effect is particularly apparent in patients with elevated complication risk at baseline. Choice of mastectomy technique should be made with careful consideration of patient comorbidities.
authors.affiliation: Division of Plastic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: Akhil K
authors.initials: AK
authors.lastname: Seth
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Hirsch
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mustoe
authors.forename: Robert D
authors.initials: RD
authors.lastname: Galiano
authors.forename: Nora M
authors.initials: NM
authors.lastname: Hansen
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local