Closed Incision Negative Pressure Therapy in Oncoplastic Breast Surgery: A Comparison of Outcomes

Abstract

Background: We aim to discern the impact of closed incision negative pressure therapy (ciNPT) on wound healing in the oncoplastic breast surgery population. Methods: A retrospective analysis was conducted on patients who underwent oncoplastic breast surgery with and without ciNPT in a single health system over 6 years. Oncoplastic breast surgery was defined as breast conservation surgery involving partial mastectomy with immediate volume displacement or replacement techniques. Primary outcomes were rates of clinically significant complications requiring either medical or operative intervention, including seroma, hematoma, fat necrosis, wound dehiscence, and infection. Secondary outcomes were rates of minor complications. Results: ciNPT was used in 75 patients; standard postsurgical dressing was used in 142 patients. Mean age (P = 0.73) and Charlson Comorbidity Index (P = 0.11) were similar between the groups. The ciNPT cohort had higher baseline BMIs (28.23 ± 4.94 versus 30.55 ± 6.53; P = 0.004), ASA levels (2.35 ± 0.59 versus 2.62 ± 0.52; P = 0.002), and preoperative macromastia symptoms (18.3% versus 45.9%; P ≤ 0.001). The ciNPT cohort had statistically significant lower rates of clinically relevant complications (16.9% versus 5.3%; P = 0.016), the number of complications (14.1% versus 5.3% with one complication, 2.8% versus 0% with >2; P = 0.044), and wound dehiscence (5.6% versus 0%; P = 0.036). Conclusions: The use of ciNPT reduces the overall rate of clinically relevant postoperative complications, including wound dehiscence. The ciNPT cohort had higher rates of macromastia symptoms, BMI, and ASA, all of which put them at increased risk for complications. Therefore, ciNPT should be considered in the oncoplastic population, especially in those patients with increased risk for postoperative complications.

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

“…Wound dehiscence has been shown to cause significant morbidity, including decreased patient quality of life, prolonged hospital stays, and increased care costs. 17,27,[31][32][33][34][35][36][37][38][39][40][41][42] Our finding is congruent with other studies examining ciNPWT in orthopedic trauma, 5,43 breast surgery, 11,14,15,44 abdominal wall reconstruction, 34,45 laparotomy, 46,47 ventral hernia repair, 48 and reviews combing multiple types of procedures. 36,41,45,[49][50][51][52] However, results in the literature are mixed, and other studies do not show this relationship.…”

“…Some studies demonstrate a benefit on rates of seroma with the use of ciN-PWT, 11,41,44,49,50,52,54,55,63 but results are mixed. [6][7][8][13][14][15]33,45,48,61 Seromas develop as a result of the accumulation of serum in internal spaces. In vivo studies have shown improved fluid flow within 4 days of ciNPWT, resulting in decreased porcine subcutaneous dead spaces and therefore reduced risk of seroma.…”

“…A systematic review and meta-analysis recently demonstrated reduced overall wound complications and flap necrosis using ciN-PWT in implant-based breast reconstruction, and several reviews have shown benefit in primary wound closure. [10][11][12][13][14][15] However, the utility of ciNPWT on donor site morbidity in MR has not been systematically reviewed to date. The purpose of this study was to assess the efficacy of prophylactic ciNPWT over standard dressings on abdominal donor site complications in MR.…”

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

“…Additionally, a surgeon may create a slight pyramid skin bridge at the T‐junction to decrease the tension at the T‐junction in higher BMI patients. Lastly, a surgeon may choose to use a closed incision negative pressure device on this higher‐risk patient population as an intraoperative dressing, which increases blood flow and decreases tension and; results in decreased wound complication and wound dehiscence rates 34 . It is also important to consider that patients with multiple co‐morbidities (chronic renal failure, obesity, smoking, significant cardiovascular disease) may not be appropriate candidates for an oncoplastic operation, and a shorter operation with a partial mastectomy alone may be a better, safer option.…”

Portable Negative Pressure Wound Dressing in Oncoplastic Conservative Surgery for Breast Cancer: A Valid Ally

“…To the best of our knowledge, few studies have compared NPWDs with standard dressings in oncoplastic breast procedures [40,43,44].…”