Comparison between bipolar scissors, monopolar electrocautery, and hydrodissection in nipple-sparing mastectomy

Background: The common techniques used in nipple-sparing mastectomy (NSM) are hydrodissection (tumescent dissection) and electrocautery. We hypothesized that bipolar scissors (diathermy scissors) would improve surgical outcomes in mastectomy. Methods: We prospectively compared 50 patients undergoing NSM using the bipolar scissor technique to retrospective data from patients who had previously undergone NSM with hydrodissection (n = 50) or electrocautery (n = 50). Operation time, intraoperative bleeding, drainage per day, duration till drain removal, and serious complications were compared. Results: Operation time was significantly better with the bipolar scissors (34.1 f 4.9 min) and hydrodissection (36.2 f 6.6 min) compared to monopolar electrocautery (53.7 f 4.8 min) (p < 0.001). Intraoperative bleeding was significantly less with the bipolar scissors (123.4 f 27.7 ml) and hydrodissection (126.6 f 25.1 ml) compared to electrocautery (161.8 f 25.0 ml) (p < 0.001). Additionally, the drainage per day and the duration till drain removal was 79.7 f 18.3 ml for 3.22 f 0.79 days and 92.4 f 41.3 ml for 3.58 f 1.23 days for the bipolar scissors and hydrodissection techniques respectively were significantly better compared to 124.8 f 40.3 ml for 4.58 f 1.23 days (p < 0.001) for the electrocautery method. Finally, the bipolar scissor technique had the least complications (2 %) compared to hydrodissection (20 %) (p < 0.004). Conclusion: Although hydrodissection was as effective as bipolar scissors in reducing operation time, intraoperative bleeding, postoperative drainage, and the duration of drainage compared with electrocautery, hydrodissection was associated with more serious complications than the bipolar scissors technique.