Aesthetic results of breast surgery can be improved

NEW YORK (Reuters Health) - As a treatment for early-stage breast cancer, a surgical team as devised a new approach to removing the cancerous tissue within the breast while preserving the skin to achieve a better cosmetic appearance without compromising the cancer treatment.

"Although breast-conserving surgeries are the most desirable choice for patients with early breast cancer, many have to abandon breast-conserving surgeries due to tumors accompanied by extended intraductal components or multiple tumors," lead author Dr. Ken-ichi Ito, from Shinshu University School of Medicine in Nagano, Japan, said in a statement. "With this new technique, selected patients can be treated for breast cancer without breast deformity."

The procedure is a three-step process beginning with "endoscopic-assisted skin-sparing mastectomy," followed by sentinel node biopsy and immediate breast reconstruction with the implantation of a mammary prosthesis.

Less invasive than conventional surgery, endoscopic surgery starts with a small incision through which the slender, camera-guided endoscope is inserted Using a blade on the tip of the instrument, the tumor and surrounding tissue is removed.

During breast cancer surgery, a sample is taken of the sentinel lymph node, the first lymph node that the lymph ducts drain into, to be sure that the cancer hasn't spread further. When breast-conserving surgery isn't possible, but a radical mastectomy isn't necessary, this approach removes all of the cancer tissue, but leaves most of the skin, enough to cover a mammary prothesis.

The study, reported in the ANZ Journal of Surgery, described 33 patients who underwent endoscopic-assisted skin-sparing mastectomy and sentinel node biopsy for early stage breast cancer, including 30 for whom immediate reconstruction with a mammary prosthesis was performed.

Postoperatively, 21 of the tumors were confirmed to be ductal or lobular carcinoma in situ and 12 were invasive malignancies. Eight of the invasive cancers had a widespread intraductal component.

Cancers in multiple locations were detected in two patients, which made standard breast-conserving surgery difficult, the authors note.

During an average follow-period of 51.2 months, none of the patients had local or regional recurrence or distant metastases.

The results suggest that for women with early breast cancer, the endoscopic-assisted approach is a suitable option that may enhance cosmetic outcomes without compromising the removal of the cancer, the researchers conclude.

SOURCE: ANZ Journal of Surgery, October 2008.