Transaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery

doi:10.1016/j.amjsurg.2008.06.028

The American Journal of Surgery

Volume 196, Issue 4, October 2008, Pages 578-581

https://doi.org/10.1016/j.amjsurg.2008.06.028 Get rights and content

Abstract

Background

Endoscopic surgery for inner-side breast cancer usually is performed by periareolar approach, but leaves deformation or malposition, and sensory disturbance. We devised an approach of retromammary route without subcutaneous removal, from an axillary skin incision, to treat distant cancers and also to preserve sensation to skin touch.

Methods

We have performed video-assisted breast surgery on 230 patients. The transaxillary retromammary-route approach was performed on 20 patients with early breast cancer. From a 2.5-cm axillary incision, we dissected the major pectoral muscle fascia to detach retromammary tissue. We cut the proximal side of the gland vertically, and dissected the skin flap over the tumor by the tunnel method. Then we cut each side of the gland vertically and removed it through the axillary port.

Results

All surgical margins were negative. The surgical time was 45 minutes longer than the conventional video-assisted breast surgery. The postoperative esthetic results were good.

Conclusions

The transaxillary retromammary-route approach leaves no injury on whole breast, and can become a single standard method for breast-conserving surgery wherever a cancer is situated.

References (11)

J. Sanuki et al.
Volume replacement with polyglycolic acid mesh for correcting breast deformity after endoscopic conservative surgery
Clin Breast Cancer
(2005)
K. Yamashita et al.
Endoscopic video-assisted breast surgery: procedures and short-term results
J Nippon Med Sch
(2006)
K. Yamashita et al.
Video-assisted breast surgery: reconstruction after resection of more than 33% of the breast
J Nippon Med Sch
(2006)
M. Yamagata et al.
Partial mastectomy by the periareolar incision
Geka Chiryo
(2002)
Y. Tamaki et al.
Transareolar endoscopy-assisted partial mastectomy : a preliminary report of six cases
Surg Laparosc Endosc Percutan Tech
(2001)

There are more references available in the full text version of this article.

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Citation Excerpt :
Recently, minimal-access breast surgery (MABS) has been promoted by several authors using a lateral, radial, inframammary, periareolar or axillary incision for both tumour resection and SLN retrieval [7–13]. Also, endoscopic, or robotic assisted breast surgery performed through minimal axillary or periareolar incisions has shown an increasing trend in the field of MABS [14–19]. Success rates varied between 90 and 100% for SLN retrieval along with comparable complication and re-operation rates, yet, with a tendency to more formation of seroma in the single-incision cohort in one study [12].
The purpose of this study was to assess the feasibility of using the single-incision round block technique in breast-conserving surgery with sentinel lymph node (SLN) retrieval for breast cancer without compromising oncological safety.
A retrospective observational case-control study was conducted from January 2017 to October 2021. The study population consisted of two groups. In both groups, breast-conserving surgery was carried out through the round-block technique. In group A, SLN retrieval was performed using the round-block incision (study group), while in group B, SLN retrieval was conducted through a second skin incision in the axilla (control group). The study was approved by the local ethics committee Zurich (BASEC-Nr. 2020–02857), and written informed consent was obtained from all participants.
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The single-incision method through the round block technique is as safe and effective as the standard two-incision approach regarding nodal staging and resection margins, and seems to be applicable for tumours in all breast quadrants.
Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures
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In our preliminary experience, E-BCS is a promising surgical technique for selected early breast cancer patients with low morbidity, acceptable oncological outcomes and high patient satisfaction.
Endoscopic-assisted surgery in the management of breast cancer: 20 years review of trend, techniques and outcomes
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Citation Excerpt :
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The American Society of Breast SurgeonsTransaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery

Abstract

Background

Methods

Results

Conclusions

Clin Breast Cancer

Endoscopic video-assisted breast surgery: procedures and short-term results

J Nippon Med Sch

Video-assisted breast surgery: reconstruction after resection of more than 33% of the breast

J Nippon Med Sch

Partial mastectomy by the periareolar incision

Geka Chiryo

Transareolar endoscopy-assisted partial mastectomy : a preliminary report of six cases

Surg Laparosc Endosc Percutan Tech

The American Society of Breast Surgeons
Transaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery