Additive risk of tumescent technique in patients undergoing mastectomy with immediate reconstruction

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.