Background:
In cosmetic and reconstructive breast surgery, de-epithelialisation involves removing epidermis to allow tissue to move beneath areas of retained skin whilst maintaining the subdermal plexus to support vascularity of a tissue flap and nipple areola complex (NAC). The process of de-epithelialisation can be tedious, time intensive and requires an assistant to maintain skin tension. To ensure the underlying vasculature within the dermis and subcutaneous tissue is preserved, the process must be exact with the average thickness of breast tissue epidermis about 0.3mm. Inadequate de-epithelialisation can lead to skin necrosis, poor flap healing, seroma, infection, and suboptimal aesthetic outcomes.
Aim:
This scoping review endeavours to synthesize existing evidence investigating the different techniques used to de-epithelialise skin during breast surgery and determine if one technique is superior.
Methods:
A comprehensive search was performed using Pubmed, Scopus, Google Scholar and the Cochrane library databases. Studies included reported the use of one or more techniques for breast tissue de-epithelialisation with the comparative value of the technique(s) discussed.
Results:
The findings revealed variation between de-epithelisation tools utilised and a lack of comparative literature to determine if any practice is superior to another. There are numerous techniques described, including: sharp dissection with a scalpel, scissors or novel devices such as EpiCut; electrocautery; laser; dermatome; hydrosurgery systems and intradermal infiltration of local anaesthetic. While some articles compare the time or cost of two or more techniques, there was no study comparing all techniques in significant detail.
Conclusion:
This review provides an overview of existing techniques used for breast tissue de-epithelialisation and some of the benefits of certain techniques. Ultimately, there is lack of comparative research that analyses the different techniques. Further research could help guide surgeon decision making and improve efficiency, cost and surgeon satisfaction when de-epithelialising breast tissue.