title: Retromammary approach for endoscopic resection of benign breast lesions.
abstract: BACKGROUND
  One of the merits of endoscopic surgery is that it can be performed through small remote incisions made in inconspicuous areas. To improve cosmetic outcomes of surgical treatment of benign breast lesions, we performed endoscopic surgery through minimally sized axillary incisions with the goal of achieving scar-free breasts.
  
  
  METHODS
  From August 2007 to August 2008, 18 patients with 20 benign breast lesions underwent endoscopic breast excision in our institution. Endoscopic resection of benign breast lesions was performed via the retromammary route with video assistance. Cosmetic results were evaluated using the five-item, four-step ABNSW scoring system, assessing breast asymmetry, breast shape, nipple shape, skin condition, and wound scars.
  
  
  RESULTS
  The median age of the patients was 27 years (IQR 23.0, 29.0). Median resected lesion size was 3.3 cm (IQR 2.9, 3.9). Median operative time was 85.0 min (IQR 70.0, 100.0). A marginally significant difference in operative times was noted between fibroadenoma and/or juvenile fibroadenoma cases and mastopathy or benign phyllodes cases (80.0 vs. 100.0; p < 0.06). Median total ABNSW score was 14 points. Postoperatively, 5 patients had mild local subcutaneous emphysema, and one had transient brachial palsy. No breast ecchymosis or deformity was noted. No major complications developed in any patient, and 89% of patients had good or excellent results.
  
  
  CONCLUSIONS
  Video-assisted endoscopic breast surgery has changed routine breast surgery, manifesting cosmetic effects that cannot be achieved by previous routine surgical techniques. Patients with multiple or large benign tumors who desire excellent cosmetic results are good candidates for this approach.
authors.affiliation: Division of General Surgery, E-Da Hospital/I-Shou University, Jaiu-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, Taiwan, Republic of China. ed100459@edah.org.tw
authors.forename: Hsien
authors.initials: H
authors.lastname: Liu
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Yu
authors.forename: Hsin-Pao
authors.initials: HP
authors.lastname: Chen
authors.forename: Pei-Min
authors.initials: PM
authors.lastname: Hsieh
authors.forename: Kao-Chen
authors.initials: KC
authors.lastname: Hung
authors.forename: Chao-Ming
authors.initials: CM
authors.lastname: Hung
authors.forename: Yaw-Sen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000328:Adult; D001365:Axilla; D001940:Breast / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D002921:Cicatrix; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020535:Video-Assisted Surgery; D055815:Young Adult