Oncological and cosmetic outcome in breast cancer patients undergoing “moving window” operation

Abstract

An inappropriate skin incision on the breast reduces the cosmetic benefit of breast-conserving surgery (BCS). To improve the cosmetic outcome, we have performed "moving window" operation in which BCS can be performed via a periareolar incision (periareolar approach) and/or axillary incision (axillary approach) under direct visualization. Axillary lymph node dissection is also performed via an axillary incision. The periareolar and axillary approaches were used in 65 and 43 patients, respectively. Average operation time was 130 min in periareolar approach and 131 min in axillary approach. Average blood loss was 37 and 50 ml, respectively. Postoperatively, the surgical margin of breast tissue was histologically confirmed to be negative in 107 (99%) of 108 patients, one patients underwent subsequently reoperation because of positive surgical margin. Fifty-two patients (85%) in periareolar approach and 37 patients (86%) in axillary approach had excellent or good cosmetic results. With a mean follow-up of 36 months, four patients developed in-breast recurrence, but three of them had neoadjuvant chemotherapy before surgery. The moving window operation can improve cosmetic outcome of BCS without compromising oncological safety. Moreover, it can reduce operation time and blood loss in comparison to endoscope-assisted BCS.

Technical Feasibility and Cosmetic Advantage of Hybrid Endoscopy-Assisted Breast-Conserving Surgery for Breast Cancer Patients

“…The wound protector is necessary to protect the wound and secure the visual field and is not expensive. 17 With regard to the surgical margin, only 1 case had exposed lesion in the margin, and q2 mm of free margin was secured in more than 90% of patients. We obtain magnetic resonance imaging images of both breasts in all BCS patients.…”

“…Requirement for expensive disposable devices is reported as one of the disadvantages of endoscopy-assisted surgery. 17 However, we use a reusable vein retractor for endoscopic dissection of the posterior surface and the tumescent method for skin flap development, which allows a minimum requirement for disposable devices. 18 The only disposable item we use is a wound protector ( Figs.…”

Present status of endoscopic mastectomy for breast cancer

“…Depending on the site of the tumor, the operative method of mastectomy, lymph node dissection, and mammary reconstruction, the moving window method from the small incised part of the skin is used under direct vision [4,5] . However, most reports show a method to exfoliate breast from the skin through a small incision using an abrasion device with an endoscope, the retractor with the endoscope, and the appliance that exfoliates with a balloon under endoscopic observation.…”

Single-incision for breast-conserving surgery through round block technique

“…Recently, minimal-access breast surgery (MABS) has been promoted by several authors using a lateral, radial, inframammary, periareolar or axillary incision for both tumour resection and SLN retrieval [7][8][9][10][11][12][13]. Also, endoscopic, or robotic assisted breast surgery performed through minimal axillary or periareolar incisions shown an increasing trend in the field of MABS [14][15][16][17][18][19]. Success rates varied between 90 and 100% for SLN retrieval along with comparable complication and re-operation rates, yet, with a tendency to more formation of seroma in the single-incision cohort in one study [12].…”