Arrica Giovanni, Tettamanzi Matilde, Ziani Federico, Filigheddu Edoardo, Trignano Claudia, Rubino Corrado, Trignano Emilio
Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Aesthetic Plast Surg. 2025 Mar;49(6):1708-1714. doi: 10.1007/s00266-024-04412-4. Epub 2024 Sep 29.
Tumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years.
During the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 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 injected diffusely throughout the mammary gland.
The average volume of tumescent solution infiltrated during TLA was 350 mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery. No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%). No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1 year.
Reduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field. The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction.
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肿胀局麻（TLA）是一种用于外科手术的麻醉方法，涉及输注含有利多卡因、碳酸氢钠和肾上腺素的盐溶液。这种麻醉技术旨在实现血管收缩和麻醉。在本文中，我们基于对过去几年收集的临床病例史的分析，提出了一种专门适用于乳房缩小术的改良TLA方案。
在2012年至2022年期间，我们对120例患者采用肿胀局麻（TLA）进行了乳房缩小术。肿胀液的成分包括在1000mL 0.9%盐溶液中加入25mL 2%利多卡因、8mEq碳酸氢钠和1mL肾上腺素（1mg/1mL）。将溶液广泛注射到整个乳腺中。
TLA期间平均每侧乳房浸润的肿胀液体积为350mL。没有肾上腺素或利多卡因中毒的病例，也没有患者需要转为全身麻醉。没有患者接受镇静。患者在术前浸润或手术期间均未报告疼痛或不适。没有因短期并发症而需要再次干预的情况。并发症包括4例血肿（3.3%）、3例血清肿（2.55%）、10例伤口裂开（8.3%）、5例不对称（4.1%）、9例T形交界处破裂（7.5%）、2例（部分）乳头坏死（1.6%）和3例脂肪坏死（2.5%）。没有报告感染或乳头乳晕完全缺失的病例。随访期为30天至1年。
乳房缩小术对于寻求改善容貌的巨乳女性来说是一种可行的手术选择。患者必须充分了解该手术相关的潜在益处和风险，并咨询该领域的专业医疗人员。肿胀局麻（TLA）的使用已被确认为一种安全有效的乳房缩小术方法，可确保充分的疼痛控制，术后并发症最少，并使患者满意度很高。
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