J Breast Cancer.  2010 Jun;13(2):138-146. 10.4048/jbc.2010.13.2.138.

Endoscopy-assisted Breast Conserving Surgery for Breast Cancer: A Preliminary Clinical Experience

• Hong YI
• Shin H

• KMID: 2286538
• DOI: http://doi.org/10.4048/jbc.2010.13.2.138

Abstract

PURPOSE
Breast conserving surgery (BCS) has replaced modified radical mastectomy as the standard treatment for early breast cancer. However, even though the original shape of the breast is preserved, the significant scarring after BCS detracts from the natural appearance of the breast. Endoscopy-assisted breast surgery can be performed with small incisions that become inconspicuous after surgery. We report herein on our preliminary clinical experience for the aesthetic and treatment results of endoscopy-assisted BCS (EA-BCS).
METHODS
We retrospectively analyzed 22 consecutive patients who underwent EA-BCS between June 2006 and February 2008. The skin incisions were made at the periareolar and axillary sites. We performed a dye- and/or radioisotope-guided sentinel lymph node biopsy (SLNB), and we dissected the axillary lymph nodes (level I and II), and excised tissue under endoscopic assistance. We carried out frozen section biopsies to rule out tumor invasion on the resection margins. The following information was obtained: the clinical and histopathological characteristics, the operative procedures, the surgical outcomes, the cosmetic evaluation, and the patients' satisfaction.
RESULTS
The average age of the patients was 52.0 years (range, 32-74 years). The mean tumor size was 2.2 cm (range, 0.7-5.5 cm). All the patients underwent EA-BCS and SLNB. The postoperative complications were as follows: lymphedema in two patients, wound infection in three patients, and a total mastectomy due to positive margins on the final biopsy report in one patient. No locoregional recurrence was observed on the follow-up study (mean, 24.0 months). There were good to excellent aesthetic results for 95% of the evaluated cases. Almost all the patients were satisfied with the outcome of surgery.
CONCLUSION
EA-BCS was a feasible and effective procedure for treating patients with breast cancer and it achieved good aesthetic results with reducing the surgical scarring. However, further study with more patients and long-term follow-up is needed.

Keyword

Breast neoplasms; Endoscopy; Segmental mastectomy

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Cicatrix
Cosmetics
Endoscopy
Follow-Up Studies
Frozen Sections
Humans
Lymph Nodes
Lymphedema
Mastectomy, Modified Radical
Mastectomy, Segmental
Mastectomy, Simple
Nitriles
Postoperative Complications
Pyrethrins
Recurrence
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin
Surgical Procedures, Operative
Wound Infection
Cosmetics
Nitriles
Pyrethrins

Figure

• 

  Figure 1 Special surgical tools for endoscopy-assisted breast surgery. (A) Alexis® Wound Retractor. (B) Bipolar scissors BiSect. (C) Visiport™ Plus. (D) ENDOPATH®. (E) Endosector LE. (F) Ultra Retractor.

• 

  Figure 2 Postoperative figures after surgery. (A) A 45-year-old at three months after EA-BCS, SLNB, and Vicryl® mesh replacement for a tumor located in the left upper-outer quadrant. (B) A 36-year-old at two months after EA-BCS and SLNB for a tumor located in the left upper-outer quadrant.

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