Surgical and Oncologic Outcomes of Tumescence and Sharp Dissection Versus Electrocautery Dissection in Minimal-Access Nipple-Sparing Mastectomy with Immediate Prosthesis Breast Reconstruction: A Real-World Retrospective Cohort Study

BACKGROUND: Minimal-access nipple-sparing mastectomy (NSM) with immediate prosthesis breast reconstruction results in better cosmetic outcomes than conventional operation. However, the impact of skin flap development techniques on postoperative complications and long-term oncologic safety is largely unknown. This report describes the surgical and oncologic outcomes of tumescence and sharp dissection compared with electrocautery dissection. METHODS: In this real-world retrospective cohort study, 5436 individuals undergoing NSM from 12 centers in China were identified. After exclusions and propensity score-matching, the study included 1252 patients who underwent minimal-access NSM with immediate prosthesis breast reconstruction between January 2016 and December 2022. Perioperative parameters, postsurgical complications, and long-term survival were analyzed. RESULTS: Of the 1252 patients, 313 (25 %) underwent tumescence and sharp dissection, and 939 (75 %) underwent electrocautery dissection. The patients in the tumescence and sharp dissection group had significantly lower rates of necrotic complications (5.8 % vs 13.0 %; p = 0.001), infection (2.6 % vs 5.6 %; p = 0.041), and implant loss (0.3 % vs 2.2 %; p = 0.025) than those receiving electrocautery dissection, with a significantly shorter operation time (median, 177 min; interquartile range [IQR], 132-219 min vs 201 min; IQR, 143-249 min; p < 0.001). The two groups did not differ significantly in 5-year overall survival (p = 0.938) or disease-free survival (p = 0.893). CONCLUSION: Tumescence and sharp dissection was associated with fewer postoperative complications and a shorter operation time than electrocautery dissection for breast cancer patients receiving minimal-access NSM with immediate prosthesis breast reconstruction, and showed no significant difference in long-term survival.