-Original-

Video-Assisted Breast Surgery: Reconstruction after Resection of More than 33% of the Breast

Koji Yamashita^1,2 and Kazuo Shimizu²

¹Department of Surgery, Nippon Medical School Musashi Kosugi Hospital
²Division of Endocrine Surgery, Department of Surgery, Nippon Medical School

Background: Improvements in reconstructive mammoplasty methods have made it possible to resect more of the mammary gland while achieving good esthetic results in breast-conserving surgery. We report the esthetic results of extended wide resection of the breast with reconstruction procedures.
Methods: Breast-conserving surgery was performed using a video-assisted breast surgery (VABS) technique. Breast reconstruction was simultaneously performed using the following three methods: mobilization of the remnant mammary gland, transplantation of the lateral tissue flap, and filling with an absorbent synthetic fiber mesh or cotton. The cosmetic results were evaluated with an original five-item-by-four-step scoring system: ABNSW-assessing asymmetry, breast shape, nipple shape, skin condition, and wound scar.
Results: From December 2001 through March 2006, we performed endoscopic VABS in 130 patients with breast diseases. The candidates were 29 patients with breast cancer who required resection of more than 33% of the mammary gland because of ductal carcinoma in situ (1 patient), multiple cancers (6 patients), widely extended lesions (20 patients), and lesions after preoperative systemic therapy (2 patients). Twenty-one patients underwent resection of 33% to 50% of the breast, and 8 underwent resection of more than 50% of the breast. All surgical margins were negative on examination of permanent histological preparations. The original shape of the breast was preserved. There was no local recurrence after follow-up times of 33 months (maximum) and 19 months (average).
Conclusions: The newly devised reconstruction methods with VABS can markedly increase the mammary gland resection volume while achieving a good esthetic outcome, ensuring a precise disease-free surgical margin, and expanding the indications for breast-conserving therapy.

J Nippon Med Sch 2006; 73: 320-327

Keywords
endoscopic surgery, breast-conserving therapy, breast reconstruction, cosmetic outcomes, breast cancer

Correspondence to
Koji Yamashita, MD, Department of Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
yamasita@nms.ac.jp

Received, July 19, 2006
Accepted, October 25, 2006