At present, more and more patients are found to have breast lumps (or nodules, localization, hypoechoic areas and foci), and a considerable number of them are inaccessible to the hand and are only detected by ultrasound. Minimally invasive rotational excision was developed in 1994 against the backdrop of women’s high demand for aesthetics and the difficulty of performing traditional surgery on inaccessible masses. However, a considerable number of patients were skeptical because they thought that minimally invasive surgery could easily leave lumps behind and that it would not be “clean”. There are also many medical professionals who think similarly, including some breast specialists who do not perform minimally invasive surgery. The fact in the end how a minimally invasive working principle and technical key Let us first briefly understand the working principle of minimally invasive rotary excisional knife: ultrasound image guidance, through a small incision of about 3 millimeters into the rotary excisional knife rod, which has a knife groove in the front of the outer casing, inside of which there can be high-speed rotary and rotary back of the inner casing, rotary cut the lesion tissue sucked into the knife groove by the negative pressure, the rotary back of the cut tissue by negative suction along with the inner sleeve with a When rotating back, the cut tissue will be taken out of the body by negative suction with the inner cannula, and so on repeatedly cutting the lesion tissue on the ultrasound image until it is finished. The geometric principle: the cylindrical specimen of a single rotary cutting as a unit, through the tightly designed spatial arrangement, covering the three-dimensional space of the lesion without omission. This is the key to achieving complete excision. It is more difficult for beginners, yet it is also what makes this technique so attractive. Can summarize the advantages of minimally invasive: take precise, tiny incision; disadvantages: expensive, easy to residual lesions under certain conditions, local bleeding or postoperative hematoma slightly greater chance. Second, the recurrence of “notorious” reasons Let us analyze why it is easy to remain “notorious”? What are the specific conditions just mentioned? The key to this technique is how to design the resection of the knife groove space arrangement process, which is an easy to learn and difficult to master the process, especially when the mass is large, it is necessary to know that the diameter of the mass doubled, the volume expanded eight times, the number of rotary incision also increased to eight times, the difficulty increases steeply. Looking back at history, this technology just entered China, the pioneers are not skilled, some of them also have the idea of “satellite”, barely do larger lumps, natural residual opportunities, which is said to be specific conditions; coupled with high-tech, expensive cost of the eye effect, resulting in the reputation of “bad! “. Third, strictly grasp the indications and improve the level of technology is the key The surgeon’s technology is qualified, the patient’s condition in line with the indications for the selection of the standard selection, the residual chance of the same as traditional surgery, and for the small lump can not be touched, can show its unique advantages. In fact, this is also a cliché: there is neither a hundred useless nor perfect things. The key is how to expand its advantages and reduce its disadvantages. I have learned a lot about this after more than a thousand resections. The main criterion I set for myself: lesions with a diameter less than the length of the incision (usually 20 mm). There are also some secondary criteria, which can be called relative contraindications: the number of masses is too large more than 3, the mass is very deep and close to the surface of the pectoralis major muscle, the mass is very irregular and rich in blood flow signals, and the mass is close to the paraspinal area, etc. In addition, in the case of multiple cases, it is necessary to remove the lesion if it is too large. In addition, minimally invasive surgery can be partially performed if necessary for those with multiple masses that are suitable, and conventional surgery for those that are not, at the same time. Minimally invasive surgery can also be performed in stages if it is beyond multiple tiny nodules. From the patient’s point of view, we can divide the breast nodules into four categories: 1, the lump is very large, palpable, the diameter exceeds the criteria for minimally invasive indications: only traditional surgical biopsy. 2, The lump is large, palpable, and also meets the size criteria and other requirements for minimally invasive: it can be biopsied minimally invasively or by traditional surgery. 3, The mass is very small, inaccessible, and meets all the criteria for minimally invasive size and other criteria: only minimally invasive surgical biopsy is possible. 4, The mass is very small, meets the size criteria for minimally invasive, but is a relative contraindication: a, the surgeon decides whether or not to perform a minimally invasive biopsy for the patient based on his or her surgical skills, combined with the patient’s wishes. b, if not minimally invasive, the nodule is BI-RADS grade 4 and above, only major invasive traditional surgical biopsy; c , if not minimally invasive, the nodule is grade 3 or 2, close ultrasound or MRI follow-up is recommended, and the way of follow-up is shown in my another article. The role of minimally invasive surgery is firstly diagnosis, and secondly treatment By the way, to clarify some other views on minimally invasive surgery that are biased: the primary mission of this technology is still diagnosis (both biopsy, which is currently known as the gold standard of the highest level of diagnosis, and foreign countries are still mainly regarded as a diagnostic tool), and secondly treatment of benign lesions, i.e., complete resection. Therefore, when the biopsy of cancer, don’t think that the money spent is “wasted”, and if you know that you have to open a big knife, don’t spend a lot of money to buy a small incision, in fact, you will feel lucky from another angle, fortunately, it is found early, otherwise, the consequences of the delay are unimaginable, especially for the untouchable early and early stage of the cancer; don’t be furious when you have a biopsy of the lobular hyperplasia. Don’t be furious when the lobular hyperplasia is detected by biopsy, for the current level of ultrasound image can’t distinguish some hyperplasia nodules and tumors, and who dares to guarantee that it’s not a tumor if no biopsy is taken? The difference between recurrence and reoccurrence In addition, don’t think that you should “cut off the root of the tumor with one cut” after spending a large amount of money, and enjoy peace forever. We have to distinguish between “recurrence” and “relapse” in the case of postoperative lumps. Recurrence is the growth of a new lump in another part of the body, or even in a neighboring part of the body. Tumor development is determined by the internal environment of the breast, and surgical removal of the lump does not change the internal environment, so it will not increase or decrease the risk of recurrence. Moreover, the more lesions are found at the time of surgery, the more it indicates that the patient has the “quality” of easy to grow tumors, and the more it predicts that the patient will be prone to recurrence. Adjusting diet and mood and treating active lobular hyperplasia 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 rate of recurrence. This is not a cop-out, but rather a matter-of-fact statement. Doctors should approach every surgery with seriousness and even trepidation, while striving to improve their surgical skills to minimize the chances of residuals. This should never be used as an excuse to relax and operate casually, in which case they would become the giant thieves with spirits as described by Sun Simiao in “The Great Physician’s Essence”. Both doctors and patients should work together to achieve the best diagnostic and therapeutic results with this technique.