title: Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast.
abstract: BACKGROUND
  The endoscopic surgery for inner-side cancer of the breast is usually performed by periareolar approach, but it often makes deformation or malposition of nipple and areola. The trans-axillary approach is favorable without making any injuries on breast skin. Furthermore, we devised a new approach of retro-mammary route without subcutaneous exfoliation, from axillary skin incision, to preserve skin touch sensation.
  
  
  METHODS
  We have performed video-assisted breast surgery (VABS) on 200 patients since December 2001. The newly devised trans-axillary retromammary-route approach (TARM) was performed on 12 patients of early breast cancer. After endoscopic sentinel lymph node biopsy, we lengthened the axillary skin incision to 2.5 cm, and dissected retromammary tissue from superficial pectoral fascia onto major pectoral muscle below the tumor. The working space was made by lifting traction sutures through the gland. We cut the gland vertically at free margin 2 cm apart from the tumor edge, and dissect skin flap over the tumor. The breast reconstruction was done by filling absorbable fiber cotton.
  
  
  RESULTS
  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 longer but the blood loss was not different. The postoperative esthetic results were good. The sensory disturbance was minimal. All patients were satisfied with this operation.
  
  
  CONCLUSIONS
  This newly devised TARM approach need no injury on whole breast, and can become a single standard method for breast conserving surgery wherever the cancer situated.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Nippon Medical School, Tokyo 113-8602, Japan. yamasita@nms.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D020535:Video-Assisted Surgery / Q000379:methods*