Skin Sparing Mastectomy Made Easy with the Use of LigaSure ImpactTm and Tumescent Local Anaesthesia: Towards Technical Standardization

Aim: To describe and evaluate skin sparing mastectomy (SSM) with the use of Ligasure ImpactTm instrument under tumescent local anaesthesia. Methods: 15 patients with a mean age of 43.8 years having early breast cancer operated from Jan. 2011 through August. 2012 by SSM under tumescent technique of local anaesthesia with the use of the LigaSure ImpactTm variety instrument of the electrothermal bibolar vessel sealing system applied to grasp, seal and cut the subcutaneous fat by its long curved jaws along the plane of superficial layer (SL) of superficial fascia (SF) to uniformly dissect the flap in a centripetal manner through the small confine of the periareolar hole. Data of operative time, blood loss, flap thickness, exposed white dermis, number of dissected axillary nodes, biopsies for presence of duct epithelium in flap inner surface, inframammary fold (IMF) and periareolar skin as well as imprint cytology from the flap in close proximity with the tumor were recorded. Hematoma/seroma formation, flap necrosis, fat necrosis and local recurrence (LR) were also recorded. Results: Mean operative time was 70.6 minutes, mean number of dissected nodes was 16.5, mean flap thickness was 5.6mm with no exposure of white dermis. Duct epithelium was nt detected in biopsies from flap inner surface but was identified in IMFand periareolar skin. Imprint cytology in proximity of the tumor was negative. One case of hematoma, one with partial flap necrosis and one with fat necrosis were reported. None developed local recurrence within 6-12 months follow-up period. Conclusion: SSM can be made easy under tumescent local anaesthesia with the novel use of LigaSure impactTm instrument with the advantage of an oncologically orthodox breast skin flap fashioning in a short time with minimal blood loss, avoiding complications of prolonged general anaesthesia and hazard of blood transfusion in malignancy operations.