Abstract P4-10-08: Trans-Axillary Retro-Mammary Approach of Video-Assisted Breast Surgery Uses Single Port in the Axilla and Treats Any Tumors Even in the Medial or Lower Side of the Breast
Authors: Yamashita K. 
Published: April 2011

Abstract
Background: The breast conserving surgery and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. When the tumor exists in the medial or lower side of the breast, we usually use the periareolar incision. However, it often makes deformation or malposition of nipple and areola, and sensory disturbance around them. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor even in the medial or lower side of the breast without making any injuries on the breast skin. And it can preserve skin touch sensation. Methods: We have performed video-assisted breast surgery (VABS) on 300 patients since December, 2001. The newly devised TARM was performed on 120 patients of early breast cancer, stage I and II. After endoscopic sentinel lymph node biopsy, we elongated the axillary skin incision to 2.5 cm. We marked the surgical margin 2 cm apart from the tumor edge by injecting blue dye into subcutane and retromamma. We dissected major pectoral muscle fascia to detach retromammary tissue under the tumor. The working space was made by lifting traction sutures through the gland. We cut the proximal side of the gland vertically at dye marking points, and dissect skin flap over the tumor by tunnel method. Then we cut each sides of the gland vertically and removed it through the axillary port by using Endocatch, tumor collection bag. The breast reconstruction was done by filling absorbable fiber cotton, oxidized cellulose. Results: The tumor size was 2.2 cm on average. The patient age was 50.2 years. We had to take much care not harming the skin over the tumor. TRAM was performed without major complications. The working space was made only enough for the resection of the gland without excessive detachment of the surrounding subcutaneous tissue. The fifty tumors in the medial side of the breast were resected in success by TARM. Traction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like burn. All surgical margins were negative. The operation time was needed 45 minutes longer than the conventional VABS operation, but the blood loss and other surgical stress factors were not significantly different. The postoperative esthetic results were good. The oxidized cellulose cotton was good for preserving the breast form, because it collects fluid to make temporal seroma and became a solid fibrous mass on six months after surgery. The average follow up period is 60 months. There was only two local recurrences. The sensory disturbance was minimal. All patients were satisfied with this operation. Conclusions: This newly devised TARM approach of VABS needs no injury on the whole breast, and can become to be a standard method of the breast conserving surgery for early breast cancer wherever it may exist in the breast.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-08.