A large amount of clinical data has confirmed that there is no relationship between postoperative recurrence of breast cancer and the choice of surgery. Breast-conserving surgery, modified radical surgery, and modified radical surgery with breast reconstruction, which are eligible for breast-conserving surgery, have the same chance of recurrence and there is no difference in survival time after surgery. Breast-conserving surgery has a slightly higher rate of local recurrence than modified radical surgery.
What kind of breast cancer patients can undergo breast-conserving surgery?
Applicable to
1.Willing to have breast-conserving surgery
2.Single lump
3.Lump size less than 3cm
4.Emphasis on the ratio of breast volume to tumor volume
5.The distance from the nipple areola area is currently not an absolute contraindication. Except for cases with clear involvement of the nipple areola, other cases can still be safely breast-conserving.
Breast-conserving surgery is not a simple lump removal, but a complex systemic project
Pre-operative: comprehensive assessment of the extent of the lump, pre-determine the extent of excision, and decide on the post-excision repair method
Intraoperative: marking of the six margins of the internal and external upper and lower anterior and posterior, and intraoperative rapid pathology to confirm the absence of cancer involvement
Postoperative: In addition to chemotherapy according to the risk of recurrence assessment, radiotherapy must be added.
Breast-conserving surgery in advanced version: minimally invasive breast-conserving surgery
Breast conservation is not the removal of a breast lump, nor is it just a partial mastectomy; it is not the preservation of a pile of flesh on the chest, but the preservation of beauty, and thus the preservation of self-confidence due to the preservation of beauty in appearance, thus improving the quality of life. On the one hand, we must focus on safe cutting edges, which means ensuring the safety of the treatment, and on the other hand, we must focus on repairing and preserving a relatively perfect shape. Simply cutting out and leaving a big pit is naturally not desirable; with a good-sized incision, although it is also filled and the shape is basically okay, that huge scar will also still be daunting. How to complete safe excision and complete satisfactory repair with a small hidden incision, Zhongshan Hospital Breast Surgery Department has done a lot of work in minimally invasive breast conservation surgery and achieved satisfactory results. As a national center for minimally invasive treatment, lumpectomy for radical gastric cancer, lumpectomy for radical intestinal cancer, and robotic surgery have become routine surgeries in Zhongshan Hospital, and we are also the first in Shanghai to carry out minimally invasive breast-conserving surgery using lumpectomy and minimally invasive subcutaneous total excision of breast cancer with lumpectomy lymph node dissection and one-stage breast reconstruction, which ensures the same efficacy as modified radical surgery and minimizes the physiological and psychological trauma of surgical intervention on breast cancer patients. On the basis of the same efficacy as the modified radical surgery, we can minimize the physical and psychological trauma of surgical interventions on breast cancer patients, and minimize the impact of surgery on patients’ body shape, thus striving for the physical and mental healing of breast cancer patients.
Except for those who cannot be breast-conserved, breast-conservation is possible.
What kind of breast cancer cannot be breast-conserved?
1.Can’t receive radiotherapy.
2.Tumor involvement in the nipple areola area.
3.Unable to guarantee negative margin.
4. The tumor is so large that negative margins cannot be guaranteed or the breast shape changes greatly after breast conservation.
What is the definition of large change in breast shape?
Three aesthetic features of the breast.
1.The position of nipple areola area
2.The volume of the breast
3. the lower crease line of the breast.
A good breast conservation surgery should not only meet the above three aesthetic requirements, but according to the characteristics of the obvious scars in the East, it is best to achieve a beautiful incision, that is.
1, the incision location is hidden, the best choice is next to the areola, followed by the armpit, and then the inframammary fold line.
2. Incision length control.
Here are some examples
Pre-operative markings for breast conservation surgery
Can you see that I have had one-fifth of my breast removed? Can you tell that I had an anterior lymph node biopsy and 5 lymph nodes removed?
For the layman, it’s just a small incision next to the areola;
Do you know how I used this incision for the armpit? This incision is not only for anterior post, but also for axillary lymph node dissection.
The third day after surgery, this patient’s healing ability is very good, the husband actually did not find where the incision is.
The European and American techniques of plastic breast conservation, removing part of the breast while adjusting the position of the nipple areola area, are more suitable for western women with large breasts, obvious sagging and good skin healing, in most cases both sides have to be operated on to achieve a relatively symmetrical state, and the incision is very long (8-10cm). Most oriental women do not have large or sagging breasts, and minimally invasive breast conservation surgery with small incisions and no displacement of the nipple-areola area is more suitable. The European and American breast eighths are available for reference, but they are not suitable for the small breasts of oriental women. Although everyone is now in the anti-Japanese, the good things of the Japanese still have to be learned, and this is the technique stolen from the Japanese.
Second choice
Patients who are not suitable for breast conservation but have requirements for appearance can choose minimally invasive subcutaneous total mastectomy with one-stage breast reconstruction
Only a 3cm incision next to the areola is needed to remove all the breast tissue and to reconstruct the breast at the same time.