Subpectoral dissection using an ultrasonic energy device in prosthetic breast reconstruction

Abstract

Background Ultrasonic devices have potential advantages over electrocautery surgical scalpels for muscle dissection, as they eliminate the risk of muscle contraction caused by electric currents. In this study, we investigated the outcomes of using both device types in subpectoral dissection for breast reconstruction. Methods In this retrospective single-center study, we examined the electronic medical records of female patients with non-recurrent breast cancer who underwent breast reconstruction. The patients were treated with either Harmonic Focus+ Shears (HFS) or a Bovie electrocautery scalpel (BES) between January 2015 and April 2020. The primary clinical outcomes evaluated were total drainage volume, time to drainage tube removal, and operation time. To control for confounding, outcomes were stratified based on the type of tissue expander used—either Mentor or Natrelle. Results The study included 303 patients; 155 (51.2%) were treated with HFS (mean age, 45.28±7.38 years) and 148 (48.8%) with BES (mean age, 44.41±9.37 years). Within each expander type, the frequency of drainage exceeding 30 cc per day after 21 postoperative days showed no statistical difference between the HFS and BES devices. The operation time was shorter for HFS in both the Mentor (85.13±19.81 minutes vs. 109.56±21.66 minutes, P<0.001) and Natrelle (88.09±20.64 minutes vs. 99.88±22.66, P<0.001) groups. Conclusions When controlling for the type of tissue expander as a confounding factor, HFS was associated with reduced operation time. Furthermore, it demonstrated superior clinical effectiveness compared to BES regarding operator convenience.

Keywords

• breast reconstruction
• mastectomy
• drainage
• electrocoagulation
• electronic health records