Use of Tumescent Anesthesia in Surgical Excision of Gynecomastia

Mohan, Amitabh; Rangwala, Murtuza; Rajendran, Nagamahendran

doi:10.1177/15533506211008076

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…A total of 287 articles were initially identified with our search terms, and after removal of duplicates, there were 144 distinct titles. In title and abstract review, 131 articles were excluded per the aforementioned criteria to leave 13 relevant studies 15,18,[20][21][22][23][24][25][26][27][28][29][30] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

2023

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Background Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery. Methods A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output. Results Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003). Conclusions This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.

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Section: Resultsmentioning

confidence: 99%

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

2023

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“Post Bariatric Male Chest Re-shaping Using L-shaped Excision Technique”

Ibrahiem

2022

Aesth Plast Surg

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Optimizing Gynecomastia Correction Surgery: Efficacy and Safety of Tumescent Local Anesthesia Approach

Tettamanzi,

Filigheddu,

Ziani

et al. 2024

Aesth Plast Surg

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Background Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years. Methods Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out. Results The average volume of tumescent solution infiltrated during TLA was 300 mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy. Follow-up time ranged from 30 days to 1 year. Conclusions We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique, supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies. Level of Evidence IV 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

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Use of Tumescent Anesthesia in Surgical Excision of Gynecomastia

Cited by 3 publications

References 17 publications

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

“Post Bariatric Male Chest Re-shaping Using L-shaped Excision Technique”

Optimizing Gynecomastia Correction Surgery: Efficacy and Safety of Tumescent Local Anesthesia Approach

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