Effect of microporous polysaccharide particles in patients undergoing mastectomy

      Clinical Practice Points

      • Microporous polysaccharide particles are used for surgical hemostasis. Our original study aims to promote high-quality care to breast surgical oncology patients through additional safety evaluation of this product. Existing data regarding this hemostatic agent is inconclusive to its benefit; a prior randomized control trial for this product in breast surgery patients required early closure related to funding. MPP remains a well-utilized hemostatic agent at our medical center, although its effects have not been evaluated retrospectively for our patient population. Given these considerations, we aimed to evaluate outcomes for mastectomy patients without reconstruction treated with and without MPP. We did not note a difference between the treatment groups, in terms of hematoma, infection, or time to drain removal. Our findings suggest that MPP can be considered in patients undergoing axillary surgery, such as lymphovenous anastomosis, to potentially reduce the risk of seroma.



      Microporous polysaccharide particles (MPP, proprietary name “Arista AH”), derived from purified plant starch, are used to augment hemostasis at surgery. The effect of MPP regarding short-term complications after mastectomy remains an area of ongoing investigation.


      A single-institution, retrospective chart review of patients undergoing unilateral mastectomy without reconstruction from January 2019 to 2021 was performed. Primary endpoints included antibiotic prescription, seroma or abscess drainage, readmission, wound dehiscence, and time to drain removal within 30 days of initial surgery. Wilcoxon rank sum test or Student T test was used for group comparisons for continuous variables; Chi-square test or Fisher exact test was used to evaluate the associations among categorical variables.


      190 patients were included; 119 received MPP and 71 did not. There was no difference in antibiotic prescription, infection drainage, hematoma, readmission, dehiscence, or time to drain removal with regards to MPP use. MPP treated patients were older (65.8 years vs 59.1, p<0.001) and had lower albumin levels (4.1 g/dL vs 4.3, p=0.025). Patients who underwent abscess drainage had higher body mass index (BMI, mean 36.1 vs 30.1 p=0.036). Patients requiring seroma drainage were more likely to be diabetic (12.8% vs 4%, p=0.035) and to have been treated with lymphovenous anastomosis (LVA, 15.6% vs 3.8%, p=0.009). Patients who had LVA were significantly less likely to receive MPP when compared to other groups (3.1% vs 74.7% p<0.001).


      Consider utilizing MPP in patients at higher risk of seroma, such as those undergoing axillary surgery including LVA.
      Microporous polysaccharide particles (MPP), a hemostatic agent, were evaluated for post-operative outcomes. 190 patients were retrospectively reviewed. No difference was noted between those treated with and without MPP with regards to infection, seroma, or hematoma. Lymphovenous anastomosis (LVA) patients were more at risk of seroma and less likely to receive MPP. Consider utilizing MPP in this LVA population.


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        • Marla S
        • Stallard S.
        Systematic review of day surgery for breast cancer.
        Int J Surg. 2009; 7: 318-323
        • Chavez-MacGregor M
        • Clarke CA
        • Lichtensztajn DY
        • Giordano SH.
        Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer.
        JAMA Oncol. 2016; 2: 322-329
        • Berkowitz R
        • Vu J
        • Brummett C
        • Waljee J
        • Englesbe M
        • Howard R.
        The Impact of Complications and Pain on Patient Satisfaction.
        Ann Surg. 2021; 273: 1127-1134
        • Gahm J
        • Wickman M
        • Brandberg Y.
        Bilateral prophylactic mastectomy in women with inherited risk of breast cancer–prevalence of pain and discomfort, impact on sexuality, quality of life and feelings of regret two years after surgery.
        Breast. 2010; 19: 462-469
        • Stefanek ME
        • Helzlsouer KJ
        • Wilcox PM
        • Houn F.
        Predictors of and satisfaction with bilateral prophylactic mastectomy.
        Prev Med. 1995; 24: 412-419
        • Tschan CA
        • Nie M
        • Schwandt E
        • Oertel J.
        Safety and efficacy of microporous polysaccharide hemospheres in neurosurgery.
        Neurosurgery. 2011; 69 (Suppl Operative): ons49-ons63
      1. United States Food and Drug Administration. [email protected] Summary of Safety and Effectiveness. Updated September 26, 2006. Accessed January 31, 2022.

        • Bloom JA
        • Foroutanjazi S
        • Erlichman Z
        • et al.
        The Use of Hemostatic Agents to Decrease Bleeding Complications in Breast Cancer Surgery [published online ahead of print, 2021 Jun 27].
        Am Surg. 2021; 31348211029866
        • Egeli T
        • Sevinç Aİ
        • Bora S
        • et al.
        Microporous polysaccharide hemospheres and seroma formation after mastectomy and axillary dissection in rats.
        Balkan Med J. 2012; 29: 179-183
        • Suarez-Kelly LP
        • Pasley WH
        • Clayton EJ
        • Povoski SP
        • Carson WE
        • Rudolph R.
        Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial.
        BMC Cancer. 2019; 19 (Published 2019 Jan 23): 99
        • Luong J
        • Milanese E
        • Fortino J
        • Vetto JT.
        Reduction of lymphocele rate in patients undergoing sentinel node biopsy for melanoma by intraoperative placement of plant-based hemostatic powder: Results of a prospective trial.
        Am J Surg. 2019; 217: 878-881
        • Ereth MH
        • Dong Y
        • Schrader LM
        • et al.
        Microporous Polysaccharide Hemospheres do not enhance abdominal infection in a rat model compared with gelatin matrix.
        Surg Infect (Larchmt). 2009; 10: 273-276
        • David AP
        • Zebolsky AL
        • Park AM
        • Heaton CM
        • Knott PD
        • Seth R.
        Effect of microporous polysaccharide hemospheres on anterolateral thigh free flap donor site complications.
        Laryngoscope Investig Otolaryngol. 2022; 7 (Published 2022 Mar 5): 380-387
        • Bruckner BA
        • Blau LN
        • Rodriguez L
        • et al.
        Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures.
        J Cardiothorac Surg. 2014; 9 (Published 2014 Aug 2): 134
        • Galarza M
        • Porcar OP
        • Gazzeri R
        • Martínez-Lage JF.
        Microporous Polysaccharide Hemospheres (MPH) for cerebral hemostasis: a preliminary report.
        World Neurosurg. 2011; 75: 491-494
        • Rajagopal P
        • Hakim N.
        The use of a powdered polysaccharide hemostat (HemoStase) in live donor nephrectomies controls bleeding and reduces postoperative complications.
        Transplant Proc. 2011; 43: 424-426
        • Tan SR
        • Tope WD.
        Effectiveness of microporous polysaccharide hemospheres for achieving hemostasis in mohs micrographic surgery.
        Dermatol Surg. 2004; 30: 908-914
        • Gleason S
        • Mehl D
        • Payne W
        • Parry S
        • Stein AB.
        Microporous polysaccharide hemosphere efficacy and safety in primary total knee arthroplasty.
        J Orthop. 2018; 16 (Published 2018 Dec 6): 19-24
        • Lewis KM
        • Atlee H
        • Mannone A
        • Lin L
        • Goppelt A.
        Efficacy of hemostatic matrix and microporous polysaccharide hemospheres.
        J Surg Res. 2015; 193: 825-830
        • Kunduz E
        • Aysan E
        • İdiz UO
        • et al.
        Evaluation of local hemostatic effect of microporous polysaccharide hemospheres products in thyroid surgery: a prospective randomized controlled study.
        Turk J Surg. 2019; 35 (Published 2019 Mar 1): 49-53