"Moving window" operation for breast-conserving surgery

Although endoscope-assisted surgery has been used for partial mastectomy to improve the cosmetic outcome, this procedure may be somewhat cumbersome, thereby increasing operating time and blood loss. Moreover, the use of expensive disposable endoscopic instruments is required.

We have performed partial mastectomy via a small periareolar incision (transareolar approach) and/or axillary incision (transaxillary approach) using a wound retractor and bipolar scissors without disposable endoscopic instruments in 58 patients with noninvasive or invasive breast cancer. Axillary lymph node dissection is also performed via small axillary incision using a wound retractor and bipolar scissors.

Average surgical duration was 132 min in transareolar approach and 125 min in transaxillary approach. Average blood loss was 38 and 48 ml, respectively. Postoperatively, the margin of resected breast tissue was histologically confirmed to be negative in 56 of 58 patients (97%) patients. Postoperative appearance of conserved breast was excellent in many patients, unless a large volume of breast tissue was removed.

A wound retractor provides maximum exposure with minimum incision size, thereby allows performance of breast-conserving surgery via a small periareolar and/or axillary incision in patients with a nipple-areola complex that is mobile and not small. It can reduce operating time and blood loss when compared with endoscope-assisted partial mastectomy.