Breast and endocrine surgeon Dr Jeremy Khoo led Queensland's first endoscopic nipple sparing mastectomy with immediate implant reconstruction at Princess Alexandra Hospital in July. The minimally invasive approach stands to benefit a subset of the 250 to 300 women treated for breast cancer at the PA each year.
Dr Khoo said the benefits of the procedure are both oncologic and cosmetic, with the added bonus of a shorter recovery time.
"The procedure can be achieved with a 3-4 centimetre incision placed away from the breast and enables us to do a full implant or autologous reconstruction using the same incision," Dr Khoo said.
"This technique enables excellent, magnified visualisation using a high-definition camera during the surgery but also enables the patient to recover much more quickly thanks to the small incision, compared to incisions two-to-three times longer used in the traditional open surgical technique."
Breast cancer surgery is one of the few general surgery sub specialties where cosmesis matters as much as the oncological outcome, and Dr Khoo said that is where a minimally invasive approach earns its place.
"As expected with a minimally invasive procedure, recovery is much quicker, it also reduces the cosmetic impact of breast cancer surgery," he said. "It uses equipment and techniques that we already have available for other laparoscopic general surgeries to effectively do a better operation."
For patients, the benefits add up in practical ways. There is less post-operative pain thanks to reduced tissue disruption, the hospital stay is halved to one or two days, and the return to everyday activity is halved as well, coming down to two to four weeks rather than four to eight. It also reduces risks such as surgical site infections or neurovascular compromise of the skin flaps and nipple-areolar complexes, which are more commonly associated with the traditional open technique.
The technique itself is not new, having been used overseas for some time, though this is the first occasion it has been offered here in Queensland.
"This procedure provides oncologically safe mastectomy for women with diagnosed breast cancer or those who are at high risk of breast cancer who choose prophylactic risk reducing mastectomies," Dr Khoo said.
"It has been used successfully in Taiwan, Korea, Singapore and some others, mainly because of the suitable anatomy of Asian women who tend to have smaller breasts on average."
Dr Khoo was careful to point out that the technique does not replace conventional open breast surgery, and that it will not suit every patient, whether they are being treated for breast cancer or having surgery to reduce their risk of it.
Story and image courtesy of the PAH and MSH Communications.
