Aesthetic Scar-Less Mastectomy and Breast Reconstruction

Abstract

Surgical approaches in breast cancer have been changing to ensure both oncologic safety and cosmetic results. Although the concept of “oncoplastic breast surgery” has been accepted for decades, breast and plastic surgeons have been striving to develop more advanced surgical skills that ensure non-inferior oncologic outcomes with better cosmetic outcomes. Endoscopic or robotic devices, which are currently available only for chest or abdominal surgeries, could be used for breast surgery to ensure better cosmetic outcomes. The authors refer to this surgical concept as “aesthetic scar-less breast surgery and reconstruction,” a term that encompasses the consequential concepts rather than naming it with simple technical words such as endoscopy-assisted or robot-assisted surgery. The “scar-less” term simply means leaving less of a scar, and better results can be expected by designing incisions on invisible areas. Herein, we summarize our experiences with various techniques of “aesthetic scar-less” surgery and review the existing literature on this topic.

Minimal Access (Endoscopic and Robotic) Breast Surgery in the Surgical Treatment of Early Breast Cancer—Trend and Clinical Outcome From a Single-Surgeon Experience Over 10 Years

“…NSM yields better cosmetic outcome and has proven oncologic safety; hence, it is increasingly used in breast cancer patients indicated for mastectomy (39,40). Mastectomy usually requires larger incisional wound, by adopting E-NSM or R-NSM, about 46.8% to 57.5% of wound length was spared (Table 2), approaching the goal of aesthetic scar-less mastectomy (Figure 2) (35). Compared with about 23% reduction of BCS wound length, the value of MABS was more apparent in NSM, where scar size is nearly halved (Figures 1-3).…”

“…Details of the surgical technique used for EABS (11,(13)(14)(15)31) or RABS (18,19,27,32,34) in the current study have been described previously. Endoscopic assisted or robotic assisted BCS and mastectomy (with or without breast reconstructions) were common MABS or aesthetic scar-less mastectomy (35) procedures for surgical treatments of breast cancers. Common incisions for MABS include axillary and/or areolar incisions via either dual incisions or single areolar, axillary, or lateral chest incision as per case indicated (Figure 2 and Supplementary Figure 1).…”

“…Whether breast reconstructions were performed immediately or at a later time is decided with patients and physicians' shared decision making. Breast reconstructions after minimal access mastectomy (or aesthetic scar-less mastectomy 35 ) can be performed by using an implant (cohesive gel implants or tissue expander) (13,15,34) or autologous tissue with latissimus dorsi (LD) flap (18,19) or abdominal flap (14, 24, 25) (Figure 2 and Supplementary Figure 1).…”

NIR-II and visible fluorescence hybrid imaging-guided surgery via aggregation-induced emission fluorophores cocktails

“…For some surgeries, such as breast surgery, thyroid surgery and superficial lymph node biopsy, surgeons could hide the surgical incision in hidden site or reduce the length of incision under the assistance with endoscopy. [ 43 , 44 ]. For example, minimally invasive video-assisted thyroidectomy (MIVAT) was proven as a safe and effective surgery since its introduction in the late 1990s.…”

Endoscopic Total Mastectomy Followed by Immediate Free Abdominal-based Flap Reconstruction: A Preliminary Experience Describing a Novel Approach to the “Aesthetically Scarless” Mastectomy

“…8,9,10,11,12 The principle of "aesthetically scarless" breast surgery describes an operation whereby incisions are secured out of sight and minimized within the range of oncologic safety. 13 The major advantage of endoscopic surgery over traditional surgery is that the operative incision can be both small and planned "away from the breast", allowing this principle to be successfully applied. Incisions for the ETM can be designed at the periareolar region, axillary region, mid-axillary line (where it may be hidden by the adducted arms), or inframammary fold (IMF).…”