Recent years has seen great advances in methods of surgery that are quicker, less invasive, require a shorter stay in hospital, and result in less scarring and a better quality of life for patients.
These methods – called minimally invasive surgery – have been applied to various surgical subspecialties including breast surgery.
The fundamental principle of minimally invasive surgery is to achieve the same treatment effect as standard surgery but with a decreased risk of complications and the least possible disturbance to the body and to the patient’s life.
The two main methods of minimally invasive breast surgery (MIBS) are radiofrequency excision (RFE), which is used to remove benign breast lesions, and endoscopic mastectomy (EM), which is used for breast cancer.
The former of these, RFE (Intact®), is a biopsy device that deploys a basket-like instrument percutaneously – via a puncture in the skin – and uses a radiofrequency current to cut around the abnormal tissue in the breast.
This tissue – or lesion – is encased inside the basket and is removed together with the needle. The procedure results in a tissue specimen large enough to make an accurate diagnosis.
One of the main advantages of RFE is that it can be done under local anesthesia under ambulatory setting and takes only about 30 minutes to complete. Lesions less than 1.5cm can be removed completely leaving a wound which is only around 7mm.
In addition, it requires no suturing and results in a much smaller scar than from open surgery. Side-effects, except minor bruising, are rare.
The second method, the endoscopic mastectomy, is a new minimally invasive surgery pioneered by Japanese surgeons which involves operating through small incisions with the help of special instruments used for breast augmentation.
This procedure is as effective in removing tumours as the standard mastectomy. However, wounds are smaller resulting in less cosmetic disturbance. The operation is done through two small incisions, the first in the axilla – the armpit – and the second in the breast.
In addition, this method can also be used to remove axillary lymph nodes and to insert breast implants.
There has been some concern about the safety of this procedure but with careful selection of patients, this approach has been shown to have similar local recurrence rate as the standard operation.
Source: Dr Hung Wai Ka, Specialist in General Surgery (Breast Surgery) at Hong Kong Adventist Hospital – Stubbs Road