Saline instillation into the cavity after conservation surgery for breast cancer is a safe way of improving cosmesis

Objective

To demonstrate that saline instillation is a safe and simple procedure for volume replacement after wide local excision in breast surgery.

Methods

We performed a pilot study over a 12-month period at the Chase Breast Unit. One hundred and six patients who underwent wide local excision for breast cancer had saline instilled into the surgical cavity at the time of wound closure. This was to maintain the volume and shape of the breast after removal of significant amounts of tissue. We measured the volume instilled and monitored the wound and breast postoperatively at 1 week, 2 weeks and 3 months. As is our normal practice, all patients received perioperative antibiotics.

Results

The volume of fluid instilled varied between 30 and 180 ml. The weight of tissue removed was in the range of 12–116 g. The fluid was retained within the cavity. However, in one case the wide local excision cavity unexpectedly communicated with the axillary clearance cavity and all the fluid was evacuated spontaneously through the axillary suction drain with a resultant visible reduction in the volume of the breast. There were no complications of saline instillation. In particular, there was no early or late infection in any of the 106 patients. None of the patients reported any additional discomfort or pain. There were no visible abnormalities apart from a subjective enhancement in the shape and volume of the breast. This improvement in shape and volume was maintained for the entire length of assessment (3 months).

Conclusion

Saline instillation is a simple and safe method of replacing volume after removal of significant amounts of breast tissue. Surprisingly, the benefits seem to persist. We are now proceeding to fully evaluate this technique in a formal prospective trial.