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http://dx.doi.org/10.5999/aps.2019.01130

Comparison of Harmonic scalpel and monopolar cautery for capsulectomy at the second stage of expander/implant breast reconstruction  

Kim, Ki Jae (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
Chung, Jae Ho (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
Lee, Hyung Chul (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
Lee, Byung Il (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
Park, Seung Ha (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
Yoon, Eul Sik (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
Publication Information
Archives of Plastic Surgery / v.47, no.2, 2020 , pp. 140-145 More about this Journal
Abstract
Background Capsular contracture is a common complication of two-stage expander/implant breast reconstruction. To minimize the risk of this complication, capsulectomy is performed using monopolar cautery or ultrasonic surgical instrumentation, the latter of which can be conducted with a Harmonic scalpel. To date, there is disagreement regarding which of the two methods is superior. The purpose of this study was to compare postoperative outcomes between a group of patients who underwent surgery using a Harmonic scalpel and another group treated with monopolar cautery. Methods A retrospective chart review was conducted of patients who underwent capsulectomy as part of two-stage breast reconstruction between January 2018 and February 2019 and who received at least 1 month of follow-up after surgery. Operative time and postoperative outcomes, including drainage duration, were analyzed. Results In total, 36 female patients underwent capsulectomy. The monopolar group consisted of 18 patients and 22 breasts, while the Harmonic scalpel group consisted of 18 patients and 21 breasts. There was no statistically significant difference in demographics between the two groups. The Harmonic scalpel group had a significantly shorter mean drainage duration (6.65 days vs. 7.36 days) and a smaller mean total drainage volume (334.69 mL vs. 433.54 mL) than the monopolar cautery group (P<0.05). No statistically significant difference was observed with regard to seroma or hematoma formation. Conclusions The Harmonic scalpel approach for capsulectomy reduced the total drainage volume and drainage duration compared to the monopolar cautery approach. Therefore, this approach could serve as a good alternative to electrocautery.
Keywords
Breast; Capsules; Ultrasonic vibration; Seroma;
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1 Reyna C, Lee MC. Breast cancer in young women: special considerations in multidisciplinary care. J Multidiscip Healthc 2014;7:419-29.
2 Handel N, Jensen JA, Black Q, et al. The fate of breast implants: a critical analysis of complications and outcomes. Plast Reconstr Surg 1995;96:1521-33.   DOI
3 Henriksen TF, Fryzek JP, Holmich LR, et al. Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors. Ann Plast Surg 2005;54: 343-51.   DOI
4 Caffee HH. Textured silicone and capsule contracture. Ann Plast Surg 1990;24:197-9.   DOI
5 Foschi D, Cellerino P, Corsi F, et al. The mechanisms of blood vessel closure in humans by the application of ultrasonic energy. Surg Endosc 2002;16:814-9.   DOI
6 Mittal P, Kumar A, Kaur S, et al. A comparative study of the use of harmonic scalpel versus unipolar cautery in modified radical mastectomy. Niger J Surg 2017;23:20-5.   DOI
7 Anandaravi BN, Parveen PN, Mohammed AA. A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy. Int Surg J 2017;4:1422-5.   DOI
8 Sharma AK, Kumar M, Singh A, et al. A prospective randomized study comparing ultrasonic dissector with monopolar electrocautery for dissection in modified radical mastectomy. Int J Surg Sci 2019;3:149-53.   DOI
9 Alptekin H, Yilmaz H, Ozturk B, et al. Comparison of electrocautery and plasmablade on ischemia and seroma formation after modified radical mastectomy for locally advanced breast cancer. Surg Tech Dev 2017;7:7011.
10 Chang Y, Kim H, Jung S, et al. Comparison of skin-sparing mastectomy using LigaSureTM Small Jaw and electrocautery. World J Surg Onc 2017;15:129.   DOI
11 Khan S, Khan S, Chawla T, et al. Harmonic scalpel versus electrocautery dissection in modified radical mastectomy: a randomized controlled trial. Ann Surg Oncol 2014;21:808-14.   DOI
12 Sutton PA, Awad S, Perkins AC, et al. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg 2010;97:428-33.   DOI
13 Kiyingi AK, Macdonald LJ, Shugg SA, et al. Harmonic dissection versus electrocautery in breast surgery in regional Victoria. ANZ J Surg 2015;85:358-62.   DOI
14 Anlar B, Karaman N, Dogan L, et al. The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications after modified radical mastectomy. Eur Surg 2013; 45:286-90.   DOI
15 Galatius H, Okholm M, Hoffmann J. Mastectomy using ultrasonic dissection: effect on seroma formation. Breast 2003; 12:338-41.   DOI
16 Burdette TE, Kerrigan CL, Homa K. Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial. Plast Reconstr Surg 2011;128:243e-249e.   DOI