Endoscopic‐assisted Skin‐sparing Mastectomy Combined With Sentinel Node Biopsy

Abstract

Breast-conserving surgery (BCS) has been carried out as desirable choice for patients with early-stage breast cancer. However, many patients obliged to abandon BCS because of tumours accompanied by extended intraductal components or multiple tumours. The purpose of this study was to develop a novel endoscopic-assisted technique for skin-sparing mastectomy (SSM) combined with sentinel node biopsy (SNB), followed by immediate breast reconstruction with mammary prosthesis. Between April 2000 and November 2006, 33 patients diagnosed with primary breast cancer underwent endoscopic-assisted SSM. Immediate reconstruction with the mammary prosthesis was carried out in 30 of 33 patients. On postoperative histopathological diagnosis, 21 tumours were diagnosed as ductal carcinoma in situ or lobular carcinoma in situ. Twelve tumours were diagnosed as invasive carcinoma. Eight of 12 invasive carcinomas were accompanied by a wide spreading intraductal component. Two patients were diagnosed as having multicentric carcinomas, which made the standard breast-conserving treatment difficult. After a mean follow-up period of 51.2 months (range 16-86 months), neither locoregional recurrence nor distant metastasis has been detected. Thus, combining SSM and SNB with immediate reconstruction with the mammary prosthesis may offer the selected patients with early-stage breast cancer favourable aesthetic results without incurring additional oncological risks. The procedure could be an alternative treatment option for patients with widely spreading intraductal component or multiple tumours.

Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?

“…following an average follow-up duration of 24.1 months there was no reported LR [7,9,11,13,17,19,23,24]. However, notwithstanding some exceptions [17,24], the average duration of follow-up has been less than two years and investigators have observed LR following endoscopic resection when follow-up is extended beyond three years [15].…”

“…Ultra Retractor, HIROTECH retractor, Endoscopic Breast Retractor, etc) appears to significantly improve visualisation and aids dissection of the posterior aspect of the breast from the pectoralis fascia (see Figure 2) [7-9, 15-18, 22, 23, 25]. However, the successful use of balloon dissection has also been reported [10,24].…”

“…The most commonly employed technique is known as the 'subcutaneous tunnelling method' [7,8,10,15,16,21,24]. This method involves creating a number of subcutaneous tunnels using the endoscopic or bladeless trocar.…”

“…However, notwithstanding some exceptions [17,24], the average duration of follow-up has been less than two years and investigators have observed LR following endoscopic resection when follow-up is extended beyond three years [15]. Only two non-randomised studies have compared the rates of LR between patients undergoing endoscopic subcutaneous mastectomy versus open breast conserving surgery [13] and versus open subcutaneous mastectomy [19].…”

“…Tumour size appears to be the single most important eligibility criteria defining entry into endoscopic mastectomy trials. Several researchers have limited their trials of endoscopic breast cancer surgery to T1 and small T2 tumours (<3cm in size) [14,18,[21][22][23], whilst others have included patients with larger T2/T3 tumours (>3 but <6cm) and/ or multifocal disease [11,[15][16][17]24]. Patients with a distribution of invasive disease that would otherwise be suitable for standard BCS, but in whom post-operative radiotherapy was not deemed acceptable were also candidates for endoscopic mastectomy in certain trials [18].…”