Endoskopische Verfahren in der ästhetischen Mammachirurgie

Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction

Endoscopic techniques are promising in breast surgery. In order to create working space, liposuction is widely used in video-assisted breast surgery (VABS). However, the use of liposuction is likely associated with side effects that may partly limit the application of VABS. Therefore, a new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. A total of 106 female patients underwent VABS, with special adaptation of the video-assisted surgical procedures previously described. Differing from other endoscopic surgery techniques, our adaptations of VABS included the selection of the working instruments, trocar placement, creation of working space, order of axillary lymph node dissection and method of mastectomy. The operative time was 50–180 min (mean, 85.5 min). The intraoperative blood loss ranged from 20 to 100 ml (mean, 48 ml). The mean lymph node number harvested was 11.5 (range, 6–31). No serious intra- or postoperative complications were recorded. There was no axillary tumor relapse, trocar site tumor implantation or upper limb edema. Without prior liposuction, our new technique of VABS reduced the blood loss volume, endoscopic surgery time, total volume of drainage fluid and, most importantly, the risk of port-site metastases. This new technique appears to have great clinical potential and good prospects for future endoscopic breast surgery development.

Anatomy and tensile strength of the abdominal head of the pectoralis major muscle in relation to transaxillary breast augmentation

BACKGROUND

This study aimed to elucidate the anatomy of the abdominal head of the pectoralis major (AHPM) in relation to transaxillary breast augmentation (TBA).

METHODS

In 20 hemithoraxes of fresh Korean cadavers, the width, thickness, and location of the origin of the AHPM were measured in relation to the seventh rib-costal cartilage junction. A force gauge was used to measure the force needed to detach the AHPM from its origin. In another four breasts, an implant pocket was made first, followed by observation of the AHPM. In 92 patients who underwent surgery, the AHPM was observed at its origin during performance of endoscopic TBA.

RESULTS

The AHPM was observed in 23 (96%) of 24 hemithoraxes dissected. The AHPM was observed in 170 (92.4%) of 184 breasts subjected to surgery. The AHPM originated from the rectus fascia at the sixth (60%) and seventh (35%) costochondral junctions. The width of the AHPM was 23.5±5.2 mm at its origin, 15.2±3.9 mm at midbelly, and 7.3±4.3 mm at insertion. The thickness of the AHPM at its origin was 1.6±0.5 mm. The force needed to detach AHPM from its origin was 23.5±12.0 N. In two cadavers of mock surgery, the AHPM could limit the boundary of the implant pocket after division of the costal origins. After division of the AHPM, the free inferior space was obtained.

CONCLUSION

In submuscular or dual-plane breast augmentation, the AHPM should be cut to place the implant in the correct desired position.

LEVEL OF EVIDENCE III

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