Discussion
tumor, breast cancer, violent lipolysis, intraoperative hemorrhage, paresthesia, allergy, hemorrhage, hypercapnia, upper limb edema
TUMOR, RECURRENCE, SUBCUTANEOUS EMPHYSEMA, SCAR, POSTOPERATIVE COMPLICATIONS, BREAST CANCER, INTRAOPERATIVE HEMORRHAGE, DISEASE, PARESTHESIA, ALLERGY, POSTOPERATIVE HEMORRHAGE, HEMORRHAGE, LENS, GAS EMBOLISM, LEAKAGE, COMPLICATIONS
In this breast cancer study, two approaches for periareolar-incision breast-conserving surgery were compared: first, a combination with traditional MALND, and, second, a combination with SMALND. The second case had little postoperative drainage volume, short drain removal time with quicker recovery, and satisfying breast conservation. There were no significant differences in postoperative complications between the two groups. The surgery helped treat this disease, while it also conserved the patient’s breasts. As a result, it helps improve the quality of life of the patient.The postoperative body image of a breast cancer patient severely affects his or her wellbeingWhen the tumor is in a non-central area, the tissue behind the areola can be kept. With the present approach, surgical incisions rarely exceed 1/4 of the perimeter of the areola to avoid damage to the blood vessels of the flap as much as possible. Therefore, complications of NAC ischemia rarely occur. The size of the areola directly affects the length of the incision; thus, to ensure surgical operation and vision, the scope of the incision exceeds a quadrant. However, to ensure the blood supply of NAC is not affected, the size of the periareolar incision should not exceed half of the total perimeter of areola.When the tumor is far from the areola and located at the periphery of a gland, it is important to resect the tumor if the outer gland is slightly pushed from outside of the tumor toward NAC. If, before the surgery, it is unclear whether the tumor can be touched, the tumor should be accurately located from the body surface via ultrasound after the patient’s surgical position has been fixed. This is crucial to accurately resect the tumor and cut as less normal glands as possible, which is needed not to change the breast appearance. Under the premise that the superficial and basal negative resection margin is ensured, the superficial and deep adipose tissue of the tumor is not completely resected because a small amount of those kinds of tissues are not related to local recurrence. Nevertheless, their preservation is essential to keep the normal contour of the breast and obtain satisfactory cosmetic effectsEndoscope-aided techniques for the application of breast-conserving surgery have mainly resolved the problem of notorious auxiliary incision scars, as seen after traditional breast-conserving surgery combined with axillary lymph node dissection. Mastoscopic axillary lymph node dissection has become a widely used surgical option for axillary lymph node dissection in breast cancer patients. Literature shows that, after these patients undergo mastoscopic axillary lymph node dissection, their postoperative recovery time is short, and the incidence of complications, including upper limb edema and paresthesia, is evidently lower than that of traditional axillary lymph node dissectionThrough mastoscopic axillary lymph node dissection, axillary nerves, blood vessels, and lymph tubes can be magnified by 8–10 times via endoscope, which allows seeing lymph nodes, axillary veins, thoracodorsal nerves and blood vessels, intercostobrachial nerves, and lymph tubes. During the procedure, the dissection also mostly retains intercostobrachial nerve, avoids damage to blood vessels, nerves, and lymph tubes, evidently reduces intraoperative hemorrhage and postoperative hemorrhage, shortens the postoperative time of indwelling drainage tube, and lowers the risks of the incidence of postoperative upper limb edema and paresthesia. These outcomes improve patients’ postoperative survival and quality of life.During the procedure of mastoscopic axillary lymph node dissection, the establishment of axillary space has become one of the key aspects; a narrow and small axillary space is usually established by inflation. Axillary space established through traditional inflation is relatively unstable because the surgical vision can be reduced due to air leakage; moreover, the mist produced by the hemorrhage of minute blood vessels and the hemostasis with an electric hook in the small space results in the blur of the lens, which severely affects the operation and prolongs surgical time. Furthermore, if COIn order to resolve the deficiencies of traditional inflated surgery and their complications, the author has presented the surgical method of non-lipolytic SMALND. In this procedure, mechanical devices are used to raise and pull axillary surface skin to replace the space demanded by mastoscopic surgery. After a 10-mm Trocar incision, vessel forceps were used to make a blunt dissection and create a lacuna that could avoid the allergy caused by solute processThe operation time of SMALD was shorter than that of MALND. Patients recover quickly after the surgery, and drain removal time and hospital discharge time were noticeably better than performing MALND after solute process.In this study, in terms of postoperative complications, there were no significant differences between the 64 patients undergoing SMALND, and the 62 patients undergoing traditional inflated mastoscopic surgery. SMALND could be used to completely replace traditional inflated mastoscopy because it can save economical expenses for patients, avoid complications such as subcutaneous emphysema, gas embolism, and hypercapnia, and also reduce surgical time and intraoperative hemorrhage volume. As a result, it enhances the recovery of patients and shortens hospitalization time.The medical device for the suspension-type procedure does not occupy any axillary space; the only requirement is to suspend the axilla from the skin surface through disinfected subcutaneous steel needles. The equipment can be installed and operated simply, and mounted reliably. On the other hand, there is almost no scar after the surgery, and there the inflated devices do not add clinical risks. This way, safe, stable and sufficient axillary operation space can be created for mastoscopic surgery. After the axillary space is formed, the endoscope can offer a clearer and wider axillary view to overcome the difficulties of narrow and small spaces typical of mastoscopic surgery. The classic problems found in traditional inflated surgery such as instability in the surgical space for using inflated devices, limitation to surgical operation, and complications such as subcutaneous emphysema and hypercapnia caused by COThe major deficiency of the suspension-type mastoscopic surgery is that it creates space after the pulling and raising force of suspension bars and steel-needle tongs, whose angles need to be adjusted to reach the equilibrium of space. However, this problem does not affect conducting the operation and its effects. It is suggested to use at least 3 steel-needle tongs to fix the axilla; this way, the axilla can be fully exposed. The axillary space is made through a blunt dissection and it avoids the allergy caused by a solute process. The omission of injection of the solution into blood vessels reduced the damage to axillary soft tissues, blood vessels, and lymph tubes caused by violent lipolysis in solute processes, and markedly shortened patients’ hospitalization time and drain removal time, promoting a quick recovery.At the same time, this study has some limitations. The number of cases enrolled in this study was small, and the observation time of postoperative complications was relatively short. Whether SMALND can replace MALND needs further big data clinical research.In conclusion, for patients in the early stages of breast cancer, periareolar-incision breast-conserving surgery combined with non-lipolytic SMALND is a safe and feasible surgical method, and a major breakthrough in mastoscopic surgery, with substantial clinical value.