Journal Logo


Efficacy of Epicut Deepithelization Blade in Bilateral Breast Reduction Surgery: A Pilot Study

Newman, Martin I. M.D.; Umansky, Jeffery M.D.; Samson, Michel C. M.D.

Author Information
Plastic and Reconstructive Surgery: April 2008 - Volume 121 - Issue 4 - p 221e-223e
doi: 10.1097/01.prs.0000305384.87991.f6
  • Free


Deepithelization is a key component of breast reduction and other plastic surgical procedures.1–5 It is commonly performed with a scalpel or scissors. Although other deepithelization techniques are reported, these methods may require special equipment. Choice of technique depends on the surgeon and is most often a matter of preference and training. A new tool was recently introduced to facilitate deepithelization, the Epicut (MicroAire Surgical Instruments, Charlottesville, Va.). This handheld, knife-like device contains a single blade, shaped like a “V,” that is designed to deepithelize in a single, cutting/shearing motion (Figs. 1 and 2). The manufacturer promises a short learning curve and reduced operating time.

Fig. 1.
Fig. 1.:
Epicut handheld tool and a standard no. 10 scalpel blade for comparison.
Fig. 2.
Fig. 2.:
Epicut in practice.

We set out to evaluate this device in practice to assess its ability to reduce operative time and complications associated with its use. Institutional review board approval was sought and granted. A side-by-side, controlled trial was carried out simultaneously by two surgeons on healthy subjects scheduled to undergo elective bilateral breast reduction surgery. Twenty consecutive subjects scheduled to undergo bilateral breast reduction were enrolled. Patients not willing to participate were excluded. Each procedure was performed by two surgeons. Surgeon A performed 10 reductions on the right using the Epicut. In those 10 cases, surgeon B performed the deepithelization on the left breast using a knife blade for five cases and a pair of scissors for five cases. For the remaining 10 cases, the surgeons switched roles. Data collected during the operation included deepithelization time (cm2), specimen weight (g), and complications. Data were compared and analyzed with standard statistical methods utilizing the t test.

The average age of the 20 subjects was 39.8 years (range, 21 to 63 years). Traditional Wise pattern reduction was used in all cases (eight superior pedicles and 12 inferior pedicles). The mean specimen weight was 967.5 g (range, 205 to 2549 g). In this pilot study, statistical significance was not achieved. Deepithelization time was calculated as a function of area deepithelized (seconds per square centimeter of breast skin treated, or seconds/cm2). In comparing the Epicut with other methods (scissors and scalpel), the deepithelization time was 5.0 versus 5.3 seconds/cm2 (SD 1.7 seconds/cm2). In comparing the Epicut with the scalpel alone, the deepithelization time was 5.0 versus 5.5 seconds/cm2 (SD 1.96 seconds/cm2), and in comparing the Epicut with scissors alone, the deepithelization time was 5.1 versus 5.0 seconds/cm2 (SD 1.58 seconds/cm2) (Table 1). No intraoperative or postoperative complications were noted in either the study group or the control group. The learning curve of the Epicut was also examined. Deepithelization time using the Epicut for the first five subjects compared with that for the last five subjects was 5.5 versus 5.0 (SD 1.98 seconds/cm2), reflecting an improvement in deepithelization time of 0.5 seconds/cm2.

Table 1
Table 1:
Deepithelization Times by Method (seconds/cm2) ( p = NS)

In this pilot study, the Epicut deepithelized breast reduction pedicles as fast as, or faster than, traditional methods. It was fastest when compared with using the scalpel and demonstrated no real difference versus the scissors. Further studies may demonstrate a significant difference. However, as with the scissors and scalpel, the Epicut will most likely prove most beneficial as a matter of surgeon preference and training.

Martin I. Newman, M.D.

Jeffery Umansky, M.D.

Michel C. Samson, M.D.

Department of Plastic and Reconstructive Surgery

Cleveland Clinic Florida

Weston, Fla.


1. Agris, J. Use of dermal-fat suspension flaps for thigh and buttock lifts. Plast. Reconstr. Surg. 59: 817, 1977.
2. Chen, Y., Chen, H., Vranckx, J. J., and Schneeberger, A. G. Edge deepithelialization: A method to prevent leakage when tubed free skin flap is used for pharyngoesophageal reconstruction. Surgery 130: 97, 2001.
3. Choi, H. Y., and Kim, K. T. A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty). Plast. Reconstr. Surg. 105: 419, 2000.
4. Ho, L. C. The small ptotic breast: Reposition autoaugmentation mammaplasty. Br. J. Plast. Surg. 39: 76, 1986.
5. Pascal, J. F., and Le Louarn, C. Remodeling bodylift with high lateral tension. Aesthetic Plast. Surg. 26: 223, 2002.

Section Description


Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:

Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at We strongly encourage authors to submit figures in color.

We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2008American Society of Plastic Surgeons