Abstract
The idea of infiltrating epinephrine-containing solution in reduction mammoplasty with the aim of reducing blood loss dates back to 1985. Although its use is fairly common among surgeons, scientific evidence supporting such use has been feeble and inconsistent. Therefore, we aimed to investigate the effects of tumescent infiltration of lidocaine- and epinephrine-containing solution on blood loss in reduction mammoplasty. A prospective, randomized, double-blinded study is planned. Forty patients admitted to our clinic for mammary hypertrophy are randomly assigned to experiment and control groups, each of a size of 20 patients. Control group underwent conventional Wise-pattern, inferior pedicle breast reduction, whereas experiment group received tumescent fluid infiltration 20 min prior to making of the incisions. Data including age, body mass index (BMI), comorbidities, operative time, length of hospitalization along with preoperative, postoperative 2nd and 12th hour complete blood counts are recorded for each patient and compared between groups. Data analysis showed no significant difference between groups in terms of age, BMI, comorbidities or preoperative hematocrit levels. Operative time and hospitalization were significantly shorter in experiment group (p < 0.05*). The drop in hematocrit level in both the 2nd (4.93 ± 2.44% to 15.53 ± 7.17%) and 12th hour (9.4 ± 6.79 compared to 21.28 ± 10.15) was lower in the experiment group (p < 0.01*). A multiple variate analysis incorporating preoperative, postoperative 2nd and 12th hour hematocrit levels demonstrated a significant reduction in blood loss with the use of tumescent infiltration (Wilks’ lambda F = 12.84, p < 0.01*). Multiple regression analysis revealed age, BMI, comorbidities, preoperative hematocrit levels and hospitalization did not affect postoperative blood loss (p > 0.05). Duration of operation, however, seemed to affect amount of blood loss postoperatively (p < 0.05*). With outcomes obtained from this study, it is clearly shown that tumescent infiltration significantly reduces blood loss in Wise-pattern, inferior pedicle breast reduction. Furthermore, tumescent infiltration is also shown to decrease operative time and length of hospital stay.
EBM LEVEL II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References:
ASPS Website. https://www.plasticsurgery.org (2020)
Kaplan JL, Rotemberg S, Yetman R et al (2008) Breast reduction: does the tumescent technique affect reimbursement? Plast Reconstr Surg 122:693–700 discussion 701
Mandrekas AD, Zambacos GJ, Anastasopoulos A et al (1996) Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients. Br J Plast Surg 49:442–446
Metz PS (1990) Autologous blood transfusion in reduction mammaplasty. Plast Reconstr Surg 85:1003–1004
Yu JC, Noone RB, LaRossa D (1990s) Autotransfusion and reduction mammaplasty: a reappraisal in the 1990s. Plast Reconstr Surg 94:328–332
Armour AD, Rotenberg BW, Brown MH (2001) A comparison of two methods of infiltration in breast reduction surgery. Plast Reconstr Surg 108:343–347
Thomas SS, Srivastava S, Nancarrow JD et al (1999) Dilute adrenaline infiltration and reduced blood loss in reduction mammaplasty. Ann Plast Surg 43:127–131
Hardwicke JT, Jordan RW, Skillman JM (2012) Infiltration of epinephrine in reduction mammaplasty: a systematic review of the literature. Plast Reconstr Surg 130:773–778
Blomqvist L, Sellman G, Strombeck JO (1996) Reduction mammaplasty with adrenaline infiltration: effects on perioperative bleeding. Scand J Plast Reconstr Surg Hand Surg 30:29–32
Brantner JN, Peterson HD (1985) The role of vasoconstrictors in control of blood loss in reduction mammaplasty. Plast Reconstr Surg 75:339–341
Hetter GP (1984) The effect of low-dose epinephrine on the hematocrit drop following lipolysis. Aesthetic Plast Surg 8:19–21
Klein JA (1990) The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin 8:425–437
Klein JA (1993) Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg 92:1085–1098 (discussion 1099–1100)
Rohrich RJ, Beran SJ, Fodor PB (1997) The role of subcutaneous infiltration in suction-assisted lipoplasty: a review. Plast Reconstr Surg 99:514–519 (discussion 520–516)
Lalonde D (2014) Minimally invasive anesthesia in wide awake hand surgery. Hand Clin 30:1–6
Bolger WE, Seyfer AE, Jackson SM (1987) Reduction mammaplasty using the inferior glandular "pyramid" pedicle: experiences with 300 patients. Plast Reconstr Surg 80:75–84
Vargas CR, Koolen PG, Ho OA et al (2015) Tumescent mastectomy technique in autologous breast reconstruction. J Surg Res 198:525–529
Khater A, Mazy A, Gad M et al (2017) Tumescent mastectomy: the current indications and operative tips and tricks. Breast Cancer 9:237–243
Coleman WP 3rd, Klein JA (1992) Use of the tumescent technique for scalp surgery, dermabrasion, and soft tissue reconstruction. J Dermatol Surg Oncol 18:130–135
Siotos C, Aston JW, Euhus DM et al (2019) The use of tumescent technique in mastectomy and related complications: A meta-analysis. Plast Reconstr Surg 143:39–48
Rosaeg OP, Bell M, Cicutti NJ et al (1998) Pre-incision infiltration with lidocaine reduces pain and opioid consumption after reduction mammoplasty. Reg Anesth Pain Med 23:575–579
Wilmink H, Spauwen PH, Hartman EH et al (1998) Preoperative injection using a diluted anesthetic/adrenaline solution significantly reduces blood loss in reduction mammaplasty. Plast Reconstr Surg 102:373–376
Christie BM, Kapur S, Kempton SJ et al (1079e) A prospective randomized trial comparing the effects of lidocaine in breast reduction surgery. Plast Reconstr Surg 139:1074e–1079e
Coleman WP 3rd, Lawrence N, Lillis PJ et al (1998) The tumescent technique. Plast Reconstr Surg 101:1751–1753
Burk RW 3rd, Guzman-Stein G, Vasconez LO (1996) Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg 97:1379–1384
Ostad A, Kageyama N, Moy RL (1996) Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 22:921–927
Llanos S, Dagnino B, Ponce D et al (2009) Effect of subcutaneous lidocaine infiltration on blood loss secondary to corporal lipoaspiration: a prospective, randomized, double-masked clinical trial. Aesthetic Plast Surg 33:738–742
Danilla S, Fontbona M, de Valdes VD et al (2013) Analgesic efficacy of lidocaine for suction-assisted lipectomy with tumescent technique under general anesthesia: a randomized, double-masked, controlled trial. Plast Reconstr Surg 132:327–332
Hatef DA, Brown SA, Lipschitz AH et al (2009) Efficacy of lidocaine for pain control in subcutaneous infiltration during liposuction. Aesthet Surg J 29:122–128
Funding
No financial or other support is obtained from a third party for production or publication of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Consent was obtained from all participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Uslu, A.B. Effect of Tumescent Lidocaine and Epinephrine Infiltration on Blood Loss in Inferior Pedicle Wise-Pattern Breast Reduction: A Prospective Randomized Study. Aesth Plast Surg 45, 442–450 (2021). https://doi.org/10.1007/s00266-020-01859-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-020-01859-z