The breast is an important sexual organ, and its integrity and beauty are important to every woman. However, sometimes the lesions must be surgically removed because of the disease, and some patients often avoid treatment for fear of post-operative scarring or local morphological changes, and some patients even pay the price of their lives for a short period of perfection.
In response to the demands of current affairs, breast surgeons have made unremitting efforts to develop surgical treatment of breast diseases in the direction of “minimally invasive, cosmetic and functional treatment”. In actual operation, we select suitable cases, combine some advanced equipment and operation techniques, and apply some cosmetic techniques to achieve the same treatment effect, while trying to achieve a better appearance of the breast, so that the patient’s psychological and physical rehabilitation to the greatest extent.
The following is a summary of the minimally invasive techniques currently carried out in our hospital.
I. Benign breast diseases
1. Transmermaiton surgery (ultrasound-guided vacuum negative pressure spinotomy)
Features: 3mm small incision, small scar after healing, accurate positioning of excision, small side injury
Suitable for: intra-mammary masses less than 2cm in diameter
2.Transmammary lumpectomy
Features: no frontal incision on the chest wall (0.5-1cm incision on the lateral chest wall), accurate intraoperative operation, less bleeding
Suitable for: male breast development surgery, injectable breast implant removal, total subcutaneous gland excision
3.Transareolar incision
Features: small scar after healing
Suitable for: Fibroadenoma, lobular tumor, excision of overflowing ducts and their respective glands, partial lobectomy
4. Small axillary incision.
Features: small and concealed incision
Suitable for: paramastectomy, axillary olfactory excision
II. Malignant diseases of the breast
Breast cancer is a systemic disease, so it is not possible to improve the survival rate of patients simply by expanding the scope of surgery, and at the same time, the huge changes in appearance or large and ugly surgical scars after surgery bring physical and psychological harm to patients, and there is also a risk of decreasing the quality of life, making it difficult for patients to return to normal family life or social environment after treatment. In the treatment of breast cancer, our department takes the international and domestic guidelines for breast cancer treatment as the basis, and combines the patient’s condition, economic and psychological needs to develop a comprehensive treatment and individualized treatment plan to meet the patient’s situation.
1.Modified radical mastectomy for breast cancer – more delicate surgery
Preserve more functional blood vessels and nerves, medial thoracic nerve and accompanying blood vessels, upper, middle and lower pectoral muscle nerves
(1) Intradermal suturing to reduce scarring in preparation for further shaping surgery
(2) Effective protection of skin flap: etc.
2.Breast-conserving surgery
Theoretical basis of breast-conserving surgery: In the 1960s, Fisher proposed that breast cancer is a systemic disease in its early stages, and hematogenous dissemination is an important route of breast cancer dissemination, which is the decisive factor of treatment effect. The main fatal risk comes from systemic metastasis. The size of local excision does not help survival.
(1) Significance: Some early-stage patients preserve most of the breast glandular tissue without affecting the overall survival rate and maintain a better postoperative breast appearance
(2) Pre-operative and intra-operative multi-disciplinary collaboration is required
Preoperatively: radiology, ultrasound and clinicians work together to localize the primary lesion
Intraoperative: intraoperative frozen examination of the specimen selected by the surgeon in all directions by the pathology department to ensure negative cut edges, and if necessary, mammograms of multiple sections of the specimen by the radiology department to ensure the distance of cut edges from the mass
Postoperative: radical radiotherapy Close clinical follow-up In the whole process of designing and implementing the treatment plan of breast-conserving surgery, the surgeon should always assume the responsibility of the planner, organizer and implementer in a comprehensive manner.
3.Transcatheter lumpectomy breast cancer surgery
(1) Trans-lumpectomy axillary lymph node dissection
Indications: Breast-conserving surgery for early-stage breast cancer, lymph nodes in the axilla that have grown up and fused are not detected by clinical examination or preoperative ultrasound
Advantages: clear vision, complete clearance, small surgical incision, more beautiful
(2) Transcatheter lumpectomy with total subcutaneous gland excision
Indications: Early stage breast cancer patients with small breasts, early stage breast cancer patients with multicentric lesions or other precancerous lesions in the breast that are not suitable for preserving the gland
Advantages: clear vision, simultaneous molding, no frontal incision on the chest wall, more beautiful
4.Sentinel lymph node biopsy
Traditional axillary lymph node dissection may lead to shoulder joint mobility disorder and ipsilateral upper limb edema, while some patients without lymph node metastasis in the axilla will not improve their survival rate by dissecting the first lymph node that may metastasize (sentinel lymph node) for biopsy, and if it does not metastasize, axillary dissection can be dispensed with, thus avoiding the occurrence of related complications.
In conclusion: We will take minimally invasive, cosmetic and functional treatment as the development direction of breast specialty in the future, and create a breast specialty featuring physiological minimally invasive and psychological minimally invasive while effectively treating the disease.