Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Via Monte Grappa 70, 07100, Sassari, Italy.
Department of Plastic and Reconstructive Surgery, "La Sapienza" University of Rome, Rome, Italy.
Aesthetic Plast Surg. 2019 Feb;43(1):7-13. doi: 10.1007/s00266-018-1181-3. Epub 2018 Jul 11.
Tumescent local anesthesia (TLA) consists of infiltration of saline solution with lidocaine and epinephrine into the tissues to obtain regional anesthesia and vasoconstriction. The use of TLA in augmentation mammoplasty has been described for sub-glandular positioning. We describe a modified TLA technique for primary sub-muscular breast augmentation reporting our experience during the past 7 years.
From 2010 to 2017, 300 patients underwent bilateral primary sub-muscular breast augmentation under TLA and conscious sedation. The tumescent solution was prepared with 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. Firstly, the solution was infiltrated between the pectoral fascia and the mammary gland, secondarily, during surgery, under the pectoralis major muscle.
The average amount of tumescent solution infiltrated while performing TLA was 740 mL per breast. No signs of adrenaline or lidocaine toxicity were reported and conversion to general anesthesia was never required. In all patients, no pain nor discomfort was reported during the pre-operating infiltration and surgical procedure. We reported a major complication rate of 3.3% (4 hematomas and 6 seromas) and a minor complication rate of 6.0% (8 implant dislocation and 10 dystrophic scars formation).
TLA represents a safe and efficacious technique for performing breast augmentation surgery with sub-muscular implant positioning. This technique guarantees good pain control during and after surgery and has low incidence of postoperative side effects. Patients subjected to sub-muscular breast augmentation with TLA were satisfied.
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肿胀局部麻醉（TLA）包括将利多卡因和肾上腺素的盐水溶液注入组织中，以获得局部麻醉和血管收缩。TLA 已被用于亚腺体定位的隆乳术。我们描述了一种改良的 TLA 技术，用于原发性胸肌下乳房增大，并报告了过去 7 年的经验。
2010 年至 2017 年，300 例双侧原发性胸肌下乳房增大患者在 TLA 和清醒镇静下接受手术。肿胀溶液由 25ml2%利多卡因、8mEq 碳酸氢钠和 1ml 肾上腺素（1mg/ml）在 1000ml0.9%生理盐水溶液中制备。首先，在胸筋膜和乳腺之间注入溶液，其次，在胸大肌下手术期间注入溶液。
行 TLA 时，平均每侧乳房浸润肿胀溶液 740ml。未报告肾上腺素或利多卡因毒性的迹象，也从未需要转为全身麻醉。在所有患者中，术前浸润和手术过程中均未报告疼痛或不适。我们报告了 3.3%的主要并发症发生率（4 例血肿和 6 例血清肿）和 6.0%的次要并发症发生率（8 例植入物移位和 10 例营养不良性瘢痕形成）。
TLA 是一种安全有效的技术，用于进行胸肌下植入物定位的隆乳术。该技术可保证手术中和手术后良好的疼痛控制，且术后副作用发生率低。接受 TLA 胸肌下乳房增大的患者满意。
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