Tumescent mastectomy: the current indications and operative tips and tricks

Ashraf Khater,1 Alaa Mazy,2 Mona Gad,2 Ola Taha Abd Eldayem,2 Mohamed Hegazy1 1Department of Surgical Oncology, Mansoura Oncology Center (OCMU), 2Anesthesia and Surgical Intensive Care Department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Tum...

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Autores principales:	Khater A, Mazy A, Gad M, Taha Abd Eldayem O, Hegazy M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Keywords: Tumescent – mastectomy – anesthesia – lidocaine Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/64c9ef2c250a4490a5eb489bd65fea5e
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spelling	oai:doaj.org-article:64c9ef2c250a4490a5eb489bd65fea5e2021-12-02T02:20:57ZTumescent mastectomy: the current indications and operative tips and tricks1179-1314https://doaj.org/article/64c9ef2c250a4490a5eb489bd65fea5e2017-03-01T00:00:00Zhttps://www.dovepress.com/tumescent-mastectomy-the-current-indications-and-operative-tips-and-tr-peer-reviewed-article-BCTThttps://doaj.org/toc/1179-1314Ashraf Khater,1 Alaa Mazy,2 Mona Gad,2 Ola Taha Abd Eldayem,2 Mohamed Hegazy1 1Department of Surgical Oncology, Mansoura Oncology Center (OCMU), 2Anesthesia and Surgical Intensive Care Department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Tumescent 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 methods: Twenty 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.Results: Although 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.Conclusion: We 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. Keywords: tumescent, mastectomy, anesthesia, lidocaineKhater AMazy AGad MTaha Abd Eldayem OHegazy MDove Medical PressarticleKeywords: Tumescent – mastectomy – anesthesia – lidocaineNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 9, Pp 237-243 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Keywords: Tumescent – mastectomy – anesthesia – lidocaine Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Keywords: Tumescent – mastectomy – anesthesia – lidocaine Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Khater A Mazy A Gad M Taha Abd Eldayem O Hegazy M Tumescent mastectomy: the current indications and operative tips and tricks
description	Ashraf Khater,1 Alaa Mazy,2 Mona Gad,2 Ola Taha Abd Eldayem,2 Mohamed Hegazy1 1Department of Surgical Oncology, Mansoura Oncology Center (OCMU), 2Anesthesia and Surgical Intensive Care Department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Tumescent 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 methods: Twenty 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.Results: Although 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.Conclusion: We 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. Keywords: tumescent, mastectomy, anesthesia, lidocaine
format	article
author	Khater A Mazy A Gad M Taha Abd Eldayem O Hegazy M
author_facet	Khater A Mazy A Gad M Taha Abd Eldayem O Hegazy M
author_sort	Khater A
title	Tumescent mastectomy: the current indications and operative tips and tricks
title_short	Tumescent mastectomy: the current indications and operative tips and tricks
title_full	Tumescent mastectomy: the current indications and operative tips and tricks
title_fullStr	Tumescent mastectomy: the current indications and operative tips and tricks
title_full_unstemmed	Tumescent mastectomy: the current indications and operative tips and tricks
title_sort	tumescent mastectomy: the current indications and operative tips and tricks
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/64c9ef2c250a4490a5eb489bd65fea5e
work_keys_str_mv	AT khatera tumescentmastectomythecurrentindicationsandoperativetipsandtricks AT mazya tumescentmastectomythecurrentindicationsandoperativetipsandtricks AT gadm tumescentmastectomythecurrentindicationsandoperativetipsandtricks AT tahaabdeldayemo tumescentmastectomythecurrentindicationsandoperativetipsandtricks AT hegazym tumescentmastectomythecurrentindicationsandoperativetipsandtricks
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Tumescent mastectomy: the current indications and operative tips and tricks

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