Harmonic Scalpel Versus Monopolar Electrotome in Endoscopic-Assisted Transaxillary Dual-Plane Augmentation Mammaplasty: A Systematic Review and Meta-Analysis of Clinical Outcomes.

BACKGROUND

Endoscopic-assisted transaxillary dual-plane augmentation mammaplasty is favored for its aesthetic advantages and minimal visible scarring. However, the optimal dissection tool between harmonic scalpel (HS) or monopolar electrotome (ME) remains debated due to limited comparative data.

METHODS

A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Cochrane Library for studies comparing HS and ME in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty. Data synthesis was performed using Review Manager 5.4 with random-effects models. Clinical outcomes were pooled as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I statistic.

RESULTS

Four studies comprising 390 participants met the inclusion criteria. HS significantly reduced total drainage volume (MD -113.40 mL; 95% CI -133.82 to -92.97; I = 10%), duration of drainage (MD -1.34 days; 95% CI -1.69 to -0.98; I = 64%), VAS pain scores within the first 24 hours (MD -2.25; 95% CI -3.53 to -0.98; I = 94%), and hospital stay (MD -1.90 days; 95% CI -3.90 to -0.71; I = 89%) compared to ME. Differences in operative time and bleeding were not statistically significant.

CONCLUSIONS

HS offers superior outcomes over ME in terms of drainage, pain control, and hospitalization following endoscopic-assisted transaxillary dual-plane augmentation mammaplasty. These findings support the preferential use of HS, though larger, high-quality trials are warranted. Trial Registry The study protocol was prospectively registered on PROSPERO (CRD42025639891).

LEVEL OF EVIDENCE II

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