At present, more and more women are found to have intra-mammary lumps (or nodules, occupancies, hypoechoic areas and lesions), and a significant number of them cannot be reached by hand and are detected only by ultrasound. It is against this background that the minimally invasive spinotomy technique was developed in 1994. However, a significant number of patients have misgivings that minimally invasive surgery is likely to leave lumps behind and that it is “not clean”. There are also many medical professionals who think similarly, even some breast specialists who do not perform minimally invasive surgery. What are the facts? 1.Minimally invasive working principle and technical key Let’s briefly understand the working principle of minimally invasive rotary cutter: under the precise guidance of ultrasound image, a small incision of about 2-3 mm is placed into the rotary cutter rod, which has a knife groove in the front of the outer casing and an inner cannula that can be rotated in and out at high speed, and when rotating in, the lesion tissue is cut by negative pressure in the knife groove, and when rotating out, the cut tissue is taken out of the body by negative suction with the inner cannula. So repeatedly cut the lesion tissue on the ultrasound image until it is cut. The geometry of this is based on a single spin of the cylindrical specimen, which is arranged in a tightly designed space to cover the three-dimensional space of the lesion without missing anything. This is the key to achieve complete excision. It is difficult for beginners, yet that is what makes this technique so attractive. The advantages of minimally invasive can be summarized: precise extraction and tiny incision; disadvantages: expensive, easy residual lesions under certain conditions, slightly greater chance of local bleeding or postoperative hematoma. Let’s analyze why the “reputation” of recurrence is notorious. What are the specific conditions just described? The key to this technique is how to design the spatial arrangement of the knife slot during resection, which is an easy to learn but difficult to master, especially when the mass is large, so it is important to know that the diameter of the mass is doubled, the volume is expanded 8 times, and the number of rotary cuts is increased to 8 times, so the difficulty increases steeply. Looking back at the history, when this technology was first introduced into China, the pioneers were not skilled, and some of them had the idea of “satellite”, and reluctantly did larger masses, which naturally had a lot of residual opportunities, and this is the specific condition mentioned; coupled with the high-tech, expensive, eye-catching effect, which led to a “bad reputation “. 3, strictly grasp the indications and improve the level of technology is the key A skilled doctor, in strict accordance with the criteria for the indications selected cases, the residual chances are the same as the traditional surgery, and for the small masses that can not be touched, more can show its unique advantages. In fact, this is also a cliché: there is neither a useless nor a flawless thing. The key is how to expand its advantages and reduce its disadvantages. After a thousand cases of resection I have learned a lot about this, and I have given myself the indication criteria of lesions less than 3 cm in length. There are some secondary criteria, which can also be called relative contraindications, such as the number of masses is too many more than 3, the masses are very deep and close to the surface of the pectoralis major muscle, the masses are very irregular and rich in blood flow signal, etc. However, specific analysis should be made on a case-by-case basis. For those who have multiple masses, if necessary, minimally invasive surgery for partially suitable masses and traditional surgery for unsuitable masses can be performed at the same time. 4. The role of minimally invasive surgery is firstly diagnostic and secondly therapeutic. By the way, to clarify some other biased views on minimally invasive surgery: the primary mission of this technology is still diagnosis (both biopsy, which is currently called the gold standard for the highest level of diagnosis, and is still mainly regarded as a diagnostic tool abroad), followed by treatment of benign lesions, i.e. complete resection. Therefore, when cancer is detected by biopsy, do not think that the money spent is “injustice”, if you had known that a major operation would be required, you would not have spent a lot of money on a small incision, but in fact, from a different perspective, you will feel glad that it was detected early, otherwise the consequences of delay would be unimaginable, especially for the early stage cancer that cannot be felt; when lobular hyperplasia is detected by biopsy, do not be angry either. The current level of ultrasound image really cannot distinguish some hyperplastic nodules from tumors, and who can guarantee that they are not tumors without taking biopsy? 5.The difference between recurrence and reoccurrence Please don’t think that after spending a lot of money, you should “cut off the root” and enjoy peace forever. We have to distinguish between “recurrence” and “relapse” in the case of lumps growing again after surgery. Recurrence is the growth of a new lump in another area, or even in the adjacent area. The occurrence of tumor is determined by the internal environment of breast, so surgery to remove the lump does not change the internal environment, so it will not increase or decrease the risk of recurrence, and the more lesions are found at the time of surgery, the more it indicates that the patient has the “quality” of being prone to tumor growth, and the more it indicates that the patient is prone to recurrence. Adjusting the diet and mood and treating active lobular growths in a timely manner may reduce this risk. Recurrence is a condition in which the original mass remains and continues to grow, and any surgery, including traditional surgery, has a certain recurrence rate. This is not to avoid responsibility, but to be realistic. Doctors must approach each surgery with seriousness and even trepidation, while striving to improve their surgical skills to minimize the chance of residuals. This should never be used as an excuse to relax yourself and operate casually, in which case you will become a giant thief containing a spirit, as Sun Simiao said in “The Great Medical Essence”. Both the doctor and the patient work together to achieve the best diagnostic and therapeutic results of this technique.