Yasushi Hachimine

Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue.

Objective:To analyze therapeutic results of video-assisted breast-conserving surgery (VA-BCS) for early stage breast cancer. Background:VA-BCS for breast cancer has been developed in Japan, and is indicated for breast cancer unaccompanied by skin involvement. The surgical incision is made at an inconspicuous site, followed by skin-sparing partial mastectomy (SSPM) and immediate reconstruction of the breast. This technique affords good cosmetic results. The long-term results are reported herein. Methods:VA-BCS was performed on 551 patients. The skin incision was made as a peri-areolar incision or at the midaxillary line. Skin-sparing partial mastectomy was performed using an endoscope and the lifting and tunneling method. Morbidity, curability, and degree of satisfaction with regard to cosmesis were analyzed. Results:Skin necrosis in 22 patients (4.0%) and necrosis of fatty tissue-muscle flap in 17 patients (3.1%) were recorded as postoperative complications. No other serious complications were encountered. Local recurrence occurred in 23 patients (4.2%) after a mean follow-up of 38.4 months. Distant-metastasis-free survival rate at 66 months was 100% for Tis, 95.5% for T1, and 90.7% for T2. Overall survival rate was 100% for Tis, 97.3% for T1, and 95.7% for T2. Degree of satisfaction with surgery as investigated by questionnaire was “good” for 76.1% of patients. Conclusion:VA-BCS for early stage breast cancer showed no association with increases in local or distant organ recurrence. The technique yielded improved cosmesis and a high degree of patient satisfaction. Follow-up observation of patients for a longer period is necessary, but VA-BCS seems useful for local treatment of breast cancer.