Evolution of minimal access breast surgery

Abstract

Surgical management of breast cancer has been evolving rapidly over the past 20-30 years. Prior to this, conventional surgical options were limited to either a mastectomy or breast conserving surgery. The demand for better aesthetic outcomes had driven the development of oncoplastic breast conserving surgery where glandular rearrangement or replacement coupled with thoughtfully placed incisions became the standard approach to breast conserving surgery. As breast surgeons and patients demand for improved aesthetic outcomes, minimally invasive or minimal access breast surgery has gained much attention over the past two decades, from endoscopic assisted to robotic-assisted breast surgery more recently. However, there has been a lack of review articles discussing this relatively recent but under-reported subset of surgical techniques in the management of breast cancer. This article aims to discuss the concept and development of minimal access breast surgery along with a review of current literature on its indications, techniques and outcome measures as well as a discussion on the strengths, limitations as well as future directions. Continued improvement in techniques and advancement of technology will definitely increase the likelihood of minimal access techniques being placed as the standard of care in the management of breast cancer.

Single-port 3-dimensional Videoscope assisted Endoscopic Nipple-sparing Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Reconstruction: Report of Two Cases

“…In large and ptosis breast, this dual axillary-areolar incision E-NSM was associated with higher complication and not easy to perform. That's one of the reasons that large or ptosis breast was not good candidate for E-NSM [1][2][3][4]6]. In these two patients, we adopted dual axillary (or lateral chest)-inframammary incision, which spare the peri-areolar skin incision to prevent blood ow interruption of NAC and decreasing NAC ischemia/necrosis complication.…”

“…In current study, we presented two cases of breast cancer patients received single port 3D E-NSM followed by IBR with pedicle TRAM ap. Minimal access breast surgery has become the new innovative surgical advance in recent two decades, and endoscopic and robotic assisted breast surgeries are the representatives [1,6,[10][11][12][13][14]. Robotic assisted NSM had been shown to have potential in NSM with small and inconspicuous scar and shown promising aesthetic results [11][12][13][14].…”

“…Implant based breast reconstruction has become the major breast reconstructions following mastectomy [17], and IBR following minimal invasive/access mastectomy (endoscopic or robotic assisted) were usually with the use of prothesis based (tissue expander or gel-lled implants) breast reconstructions [1][2][3][4], which had been shown to be associated with good cosmetic outcome. The advantage of implant based breast reconstruction following E-NSM were associated with short operation time and no additional donor site scar needed [1][2][3], which match with the characteristics of the long operation time and small-hidden scar of E-NSM.…”

“…We had adopted single-port air in ation with 3D videoscope optic system in endoscopic-NSM for the surgical treatment of breast cancer [10], and demonstrated promising cosmetic outcome for patients receiving immediate breast reconstruction (IBR) with gel implant. E-NSM was usually proposed for patients with small to medium sized breast, and prothesis type breast reconstruction was the preferred reconstruction choice [1][2][3][4]. Here, we reported two cases of breast cancer patients who presented with large and ptosis breast, who were usually not good candidate for E-NSM and IBR with gel implant.…”

“…Minimal access surgery has become one of the mainstreams of breast surgery, and it is widely used in excision of benign breast lesions, breast conserving surgery (BCS), skin or nipple-sparing mastectomy (NSM) [1][2][3]. With the improvement of endoscopic instruments, operative visualization improved and thereby facilitating oncologic resection through small incisions.…”