Drainage Collection After Endoscopic-Assisted Transaxillary Dual-Plane Augmentation Mammaplasty Using Cold or Electrosurgical Separation of Interpectoral Space

Abstract

Background: Endoscopic transaxillary augmentation mammaplasty breast augmentation offers several advantages over other augmentation methods. Nonetheless, this procedure is fraught with some problems, including greater surgical trauma due to the longer separation area. We hypothesized that cold separation of the interpectoral space could reduce surgical injury in comparison to the electrosurgical method. This study aimed to compare the outcomes of endoscopic-assisted transaxillary augmentation mammaplasty using cold separation versus electrosurgical separation of the interpectoral space. Methods: In this prospective clinical trial, cold and electrosurgical separation of the interpectoral space were achieved using a separation shovel and monopolar electrotome, respectively. A total of 20 patients who visited our department in Beijing, China, for primary breast augmentation surgeries from October 1, 2017, and May 31, 2018, were included. The primary outcome was total postoperative drainage volume. The secondary outcomes were operative time, daily drainage volume, daily pain as assessed using the visual analogue scale (VAS), and reoperation rate. Quantitative data were compared using independent-samples t test. Chi-square test was used to compare 2 classified indexes. Results: The total drainage volume was significantly lower in the cold separation group than in the electrosurgical separation group (170.45 ± 75.40 mL vs 281.05 ± 148.43 mL; P = .005). The VAS score on the first postoperative day was significantly lower in the cold separation group than in the electrosurgical separation group (6.45 ± 1.93 vs 7.55 ± 1.43; P = .048). Two (20%) reoperations owing to postoperative pain or implant stiffness were performed in the electrosurgical separation group. Conclusions: Cold separation is more conducive to reducing drainage, relieving postoperative pain, and causing less damage than the electrosurgical method in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty.

Comparison of Total and Nontotal Endoscopic Transaxillary Breast Augmentation Techniques

“…Munhoz et al 9 reported a mean operative time of 55 minutes when performing transaxillary breast augmentation without endoscopic assistance via the blunt dissection approach. In contrast, previous studies 3,8,11,12 have shown that transaxillary breast augmentation with endoscopy requires approximately 100–120 minutes. In our study, the TET group required longer operative times than the NTET group (TET vs NTET: 133.60 ± 19.68 vs 113.13 ± 21.28 minutes), but the effect was not as drastic as we had anticipated; the reduction in time with the NTET procedure was only approximately 20 minutes.…”

“…The dwelling suction drainage was still applied to those patients of 2 groups. Most of plastic surgeons in China get used to using drains after breast augmentation 3 . It could be much safer for the surgeons to observe the bleeding post operation.…”

“…These parameters can also help the surgeon decide whether to have the patient undergo secondary surgery and perform hemostasis. Li et al 3 reported that during endoscopic-assisted transaxillary dual-plane augmentation mammaplasty, cold separation after blunt dissection can significantly reduce drainage, relieve postoperative pain, and cause less damage than the electrosurgical method. However, only the foam layer, that is, the space between the pectoralis major and minor muscles, can be bluntly separated using the cold method, and the attachment of the pectoralis major muscle must be severed using an electrotome with endoscopy to form the dual plane.…”

“…Furthermore, VAS score is helpful to quantify the pain scale. Previous studies have proved that the VAS score on the first postoperative day can objectively indicate the postsurgical pain scale 3,12 . Thus we take the pain scale on the first postoperative day as the object of study.…”

“…Transaxillary augmentation mammaplasty was first described in the 1970s 3 . As the technique was based on blunt dissection, its application had been questioned, given the perceived lack of technical control compared with the more traditional inframammary approach 4 .…”