MINIMAL ACCESS BREAST SURGERY

The increasing prevalence of breast cancer in our society has produced an ever-greater demand for new diagnostic and therapeutic technologies. Today, patients ask not only that these new technologies offer improved diagnostic and treatment capabilities but also that the procedures are convenient, cost-effective, and less invasive than conventional techniques. Understandably, patients want procedures that minimize pain and trauma and have the least potential for side effects. In response, the medical community has come forward with various new technologies designed to improve the diagnosis and treatment of breast cancer while being more acceptable to patients. Routine mammography is the best screening procedure for the early diagnosis of breast cancer. Additional diagnostic tools, such as sonography, magnetic resonance imaging, and scintimammography, are now available. The additional information afforded by these technologies is intended to limit the number of patients who need further evaluation with breast biopsy. Patients requiring breast biopsies for palpable lumps now are offered minimal access procedures, such as fine-needle aspiration (FNA) or needle core biopsies, as alternatives to excisional breast biopsies. Patients with nonpalpable abnormalities are offered image-guided FNA, core needle biopsies (CNBs), vacuum-assisted procedures, or large CNBs. Breast cancer treatment has gone through two major evolutions: (1) a shift from mastectomy to lumpectomy and (2) the development of the sentinel lymph node biopsy. Both surgical procedures are minimal access, providing patients with equal, if not superior, treatment while allowing for more rapid recovery and less pain, trauma, and side effects.