Observation on the cosmetic effect of 32 cases of benign breast masses removed through hidden axillary incision
Chen Jinpeng, He Zhixian, Xu Junfei, Wang Hua, Wang Qingqing*.
[Abstract] Objective To investigate the cosmetic effect of transaxillary crease concealed incision for excision of benign breast masses. Methods Thirty-two cases of benign breast masses were excised by transaxillary crease incision to evaluate the cosmetic effect of concealed incision. The results showed that the masses were completely removed by the concealed incision through the axillary crease, and the cosmetic results were good. Conclusion The concealed incision through the axillary crease for excision of benign breast masses has good clinical application value because it causes little damage to the appearance of the breast.
【Key words】 Benign breast mass, hidden incision, axillary fold
Application value of axillary fold hidden incision of the benign breast tumor resection
Chen Jinpeng．He Zhixian.Xu Juanfei.Wang Hua.Wang Qinqin .Department of General Surgery, Affiliated Hospital of Nantong University, (jiangshu 226001, China)
[Abstract] Objective To explore the axillary fold hidden incision for operative treatment of benign breast tumor method and to improve the aesthetic effect of surgery. Methods The clinical data of 32 cases of breast benign diseases operated with the axillary fold hidden incision were retrospectively The surgical results were satisfactory. The method of the axillary fold hidden incision can be both therapeutic and beauty of double effect.
Key words】 Benign tumor; hidden incision; Axillary fold
The breast is an important organ of female sexual characteristics, and more and more patients require treatment of the disease while reducing the impact on appearance and damage. Although the minimally invasive McMurdo breast surgery has the advantages of small incision, almost imperceptible after healing, rapid postoperative recovery, and no damage to breast appearance (1). However, postoperative residual lesions are likely to occur in masses with a tumor diameter of more than 3 cm, and the deficiencies such as large trauma, breast deformation and susceptibility to hematoma, are generally not recommended for McMurdoone rotational surgery (2). In the case of subareolar nipple masses, considering factors such as nipple necrosis and large breast duct injuries, and the fact that satisfactory cosmetic results can be obtained with a concealed incision along the areola, McMurdo is not recommended.
The McMurdo procedure is also not recommended (3). In order to address the cosmetic needs of these patients, 32 cases of mammary tumor resection via concealed incision in the axillary crease were performed in our department from October 20012 to June 2014, with satisfactory cosmetic results. The results are reported as follows:
1 Data and methods
The lesions were located in the outer upper quadrant in 28 (87.5%) cases and under the nipple areola in 4 (12.5%) cases. The average diameter of the lesions was 2.4 cm (1.3-4.6 cm). Pathological diagnosis: 26 cases of breast fibroadenoma (81.25%), 5 cases of intraductal papilloma (15.63%), and 1 case of sclerosing adenopathy (3.12%)
1. 2 Surgical method The patient was placed in the lateral position, and the location and size of the tumor were marked on the surface of the breast lump by marking the position. An incision of about 3 cm in length was made along the skin crease of the axilla and the skin and subcutaneous tissues were incised, the subcutaneous tunnel was separated to the location of the mass, the gland was incised to the edge of the mass, the tumor area was fully exposed, the tumor surface peritoneum was clamped, the tumor was suspended by sutures and the mass was tracted to the bottom of the incision, the breast tissue was incised and excised completely along the edge of the mass for 0.5-1 cm, hemostasis was achieved by electrocoagulation, and the surface of the gland and the subcutaneous tissues were closed with 3-0 absorbable sutures. If the tissue defect was large, the gland was distributed on the surface of the gland and the posterior space of the breast, and the gland was repaired with a tissue fascial filling flap and high negative pressure drainage was placed.
2 Results
All 32 cases in this group had complete excision of the lesion, and all surgical incisions were grade I healed, with normal breast morphology and appearance at follow-up. In all cases, the incision scar was concealed in the axilla and was not easily detectable in regular standing and lying positions, with excellent cosmetic results and without affecting nipple areola sensation.
3 Discussion
The aesthetic needs of young and fashionable female patients must be fully considered in the selection of incisions for benign tumors. The traditional treatment of benign breast tumors is to remove the tumor by radial incision, which often leaves obvious scar and affects the aesthetics of the breast, thus some unmarried or young female patients are reluctant to accept it (4). McMurdo minimally invasive surgery is easy to operate, short operation time, small incision on the body surface, no need for suture, almost no residual scar after surgery, easy to accept by patients and high satisfaction. In recent years, the minimally invasive surgery of McMurdo has been widely used, but a considerable number of patients still choose traditional open surgery for the following reasons: ①Economic factors: the cost of McMurdo surgery is much higher than that of open surgery, and the cost of McMurdo surgery in many areas is not covered by medical insurance and rural cooperative medical reimbursement, so some patients cannot afford or are unwilling to accept it. ②Conditioning factors: for lesions larger than 3 cm, McMurdo surgery often cannot be completely removed, and the residual rate is relatively high. The incidence of postoperative hematoma is high for lesions with Doppler ultrasound suggesting rich blood flow around or inside the mass, and there is a possibility of cutting through the skin when removing superficial glandular masses (5). (3) Conceptual factors: McMurdo surgery does not remove the whole lesion, which is not in line with our surgical clinical concept of emphasizing complete excision of the mass, especially considering the possibility of malignancy in a small proportion of McMurdo pathology after surgery, which raises concerns about the completeness of its excision and the possibility of residual and increased tumor metastasis, so the concealed incision still has great practical value.
The common surgical methods of occult incision are areolar incision, inferior crease incision, axillary incision, etc. The axillary incision is suitable for lesions in the outer upper quadrant of the breast, especially lesions in the caudal lobe, which are better concealed. The disadvantage is that the incision is farther away from the lesion, the surgery is more invasive, and drainage is mostly placed. For the application of this procedure, the indications must be strictly mastered and appropriate cases must be selected. In particular, primary care units lacking laparoscopic equipment need to strictly control the indications because they cannot use laparoscopic assistance to obtain good exposure. If the nature of the mass cannot be determined and the possibility of malignancy cannot be ruled out and the patient strongly requests a cosmetic incision, a puncture biopsy can be performed first, and the pathological results will exclude malignancy before surgery.
If the tumor is far away from the incision, the assistant should assist in pushing the tumor to the direction of the incision for excision. In the operation, an incision of about 3-4 cm long is made along the skin crease of the axilla, the skin and subcutaneous tissues are incised, the subcutaneous tunnel is separated to the location of the tumor, the gland is incised to the edge of the tumor, the tumor is fully exposed, the surface of the tumor is clamped, the tumor is suspended by sutures and the tumor is pulled to the bottom of the incision, the breast tissue is incised, and the tumor is excised along the edge of the tumor by 0.5-1 cm. The depth of the incision should reach the superficial layer of the breast, and should not be too deep to prevent damage to the milk duct. If there is a large tissue defect after excision, the gland can be removed from the surface of the gland and the posterior space of the breast, and part of the gland flap can be transferred for fasciocutaneous flap formation to maintain the shape of the breast. The concealed incision through the axillary crease has an increased possibility of hematoma formation, so close hemostasis should be performed, and a drainage tube should be placed in the posterior breast space to prevent the accumulation of exudate under the flap. If the postoperative bleeding is high, it can be stopped with an elastic bandage and continuous compression.
With proper case selection, the use of a concealed incision through the axillary crease to remove benign breast masses, compared to conventional radial incisions, treats the disease while taking into account the cosmetic effect, meeting the demands of modern women who love beauty. Compared with the McMurdo spinotomy, it does not require expensive equipment investment, has excellent economy, is easy to be widely carried out in economically underdeveloped areas, and thus has good social value.
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