Endoscopy-Assisted Total Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap Reconstruction

Lai, Hsin Yi; Wu, Ho Sheng; Chuang, Kun Lin; Chen, Dar Ren; Chang, Ta-Yuan; Kuo, Shou Jen; Chen, Shou Tung; Kuo, Yiyo

doi:10.1177/1553350614546003

Cited by 34 publications

(35 citation statements)

References 32 publications

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“…Details of the surgical technique for EABS used at our hospital have been described previously [21, 22]. Briefly, after preoperative marking, the patient was placed in a supine position, and the arm was adducted for the areolar approach or was abducted 90° for the axillary approach to avoid disturbing the operative procedure.…”

Section: Methodsmentioning

confidence: 99%

Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures

et al. 2017

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BackgroundEndoscopy-assisted breast surgery (EABS), a technique that optimizes cosmetic outcome because it is performed through small wounds hidden in inconspicuous areas, could be an alternative surgical technique for benign breast tumors. In this study, we report the preliminary results of 323 EABS procedures performed at our institution for the management of benign breast tumors.MethodsThe medical records of patients who underwent EABS for benign breast lesions during the periods August 2010 to December 2015 were collected from the Changhua Christian Hospital EABS database. Data on clinicopathologic characteristics, type of surgery, hospital stay, and complications were analyzed to determine the effectiveness of the procedure for benign breast tumors. The operating time with the number of procedure performed was analyzed for learning curve evaluation. Patient satisfaction with cosmetic outcome was evaluated with a self-report questionnaire.ResultsA total of 323 EABS procedures were performed in 286 patients with benign breast lesions, including 249 (90.5%) patients with unilateral lesions. The mean age was 36 years, the mean tumor size was 2.2 cm, and the mean distance from the nipple to the tumor was 5.2 cm. Most (93.8%, 303/323) of these tumors were excised through a transareolar wound, 2.4% (8/323) through an axillary wound, and 0.3% (1/323) through the infra-mammary fold. Histopathologic analysis revealed that 63.5% (202/318) of the tumors were fibroadenoma-related lesions. The mean operative time was 81.4 min (59~89 min), which was decreased with experience increased. The overall rate of complications was 6.5%, and all were minor and wound-related. Among the 110 patients who participated in the self-report cosmetic outcome evaluation, 85.4% reported being satisfied with the cosmetic result, and almost all were satisfied with breast symmetry. Of the patients interviewed, 92.7% reported that they would choose the same procedure if they had to undergo the operation again.ConclusionsOur preliminary results show that transareolar video-assisted breast surgery is a safe and effective procedure with good cosmetic outcome and that it could be appropriate for patients with moderate to large peripherally located breast tumors.Trial registrationCCH-IRB No.15115. Registered 14 December 2015 (retrospectively registered).

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Section: Methodsmentioning

confidence: 99%

Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures

et al. 2017

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“…EABS has been shown to be an effective breast-conserving technique for early breast cancer[ 22 , 24 , 27 – 29 ]. In addition, endoscopic approaches can be used to perform skin-sparing mastectomy (SSM) and NSM [ 23 , 30 ] followed by IBR with implants[ 31 – 33 ] or autologous flaps[ 34 , 35 ]. EABS is used as an alternative to conventional surgery in select patients with early stage breast cancer in a few Western countries[ 36 ] and in some Asian countries, such as Japan[ 19 , 21 , 23 , 24 , 28 , 29 , 31 , 37 , 38 ], China[ 30 , 32 ], and Korea[ 22 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group

Lai

Chen

et al. 2016

PLoS ONE

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BackgroundEndoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.MethodsThe medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.ResultsA total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3–68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death.ConclusionThe preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique in the field of breast cancer.

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“…Regarding the selection of the surgical instruments, our choices were different from those of other studies regarding the use of short-arm dissecting forceps and scissors (9,14,21). As the distance between the incision port and the dissection working space is somewhat long, long-arm instruments were selected for the endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike the most common MALND (9,14), lipolysis and balloon expansion or other lifting devices were not required in our endoscopic surgery to help establish a gas space in axilla. In addition, the risk of trocar site tumor implantation during liposuction was eliminated.…”

Section: Discussionmentioning

confidence: 99%

“…This step described above differs from the most commonly performed MALND, in which lipolysis, balloon expansion and other lifting devices were omitted in endoscopic surgery to help establish a gas space in the axilla (9,14). We were able to establish sufficient working space, including the internal space between the posterior breast and pectoralis fascia and inflation region created by sustained air pressure of ~8 mmHg.…”

Section: Methodsmentioning

confidence: 99%

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Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction

Wu¹,

Zhu

et al. 2017

Molecular and Clinical Oncology

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Endoscopic techniques are promising in breast surgery. In order to create working space, liposuction is widely used in video-assisted breast surgery (VABS). However, the use of liposuction is likely associated with side effects that may partly limit the application of VABS. Therefore, a new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. A total of 106 female patients underwent VABS, with special adaptation of the video-assisted surgical procedures previously described. Differing from other endoscopic surgery techniques, our adaptations of VABS included the selection of the working instruments, trocar placement, creation of working space, order of axillary lymph node dissection and method of mastectomy. The operative time was 50–180 min (mean, 85.5 min). The intraoperative blood loss ranged from 20 to 100 ml (mean, 48 ml). The mean lymph node number harvested was 11.5 (range, 6–31). No serious intra- or postoperative complications were recorded. There was no axillary tumor relapse, trocar site tumor implantation or upper limb edema. Without prior liposuction, our new technique of VABS reduced the blood loss volume, endoscopic surgery time, total volume of drainage fluid and, most importantly, the risk of port-site metastases. This new technique appears to have great clinical potential and good prospects for future endoscopic breast surgery development.

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Endoscopy-Assisted Total Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap Reconstruction

Abstract: EATM followed immediately by pedicled TRAM flap reconstruction is a safe procedure and results in good cosmetic outcome in women with early-stage breast cancer.

Cited by 34 publications

References 32 publications

Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures

Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures

Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group

Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction

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