TOPICS ・Video-assisted Breast Surgery by Trans-Axillary Retro- Mammary approach 　　　　　　　　　　(TARM-VABS)     In the conventional VABS, we detached the subcutaneous tissue and made working space. But as the detached area becomes wider, the neural sensory disturbance will be severer. This surgical procedures are performed only through the axillary wound port. The mammary gland tissue of the tumor is removed through retromammary route. It avoids the disturbance of nerve and skin. It can manage all breast cancer in any location of the breast. It needs no anxiety about the deformation of nipple and areola that may occur in the periareolar approach. ・Endoscopic Sentinel Node Biopsy   We can remove the stained sentinel nodes with optical thorocar Visiport through only 1 cm long wound port. 3D-CT mammary lymphography helps safer and precise performance. Breast Conserving Surgery     This surgical procedure is an endoscopic surgery for breast diseases. The skin incision is made about 2.5 cm long on the axillary area (sometimes on periareola according to the location of the tumor). 5 mm rigid videoscope visualizes the surgical procedures on the video monitor. The cancer lesions are removed with surrounding 1〜2 cm width of mammary gland tissue. And the axillary lymph nodes are also removed endoscopically. The defect space of mammary gland is filled by the lateral chest fat tissue flap (LFT) or absorbable fiber cotton. Then the breast form is reformed. In the case of axillary node dissection, J-VAC drainage tube is inserted into the axilla for lymph flood. The skin wound is sutured with absorbable sutures and fixed with adhesive agent Dermabond. It seals up the wound and makes water-proof, then doesn't need any treatment and removement of stitches. The wound scar is very small and inconspicuous,  and hiding in the axilla. Everyone was satisfied with this procedure.     Recently, in the negative case of sentinel node biopsy, the axillary nodes are preserved. It makes better aesthetic outcomes. 　 Skin-sparing Total Mastectomy     In the case of ductal carcinoma in situ (DCIS)　with wide intraductal extension, we cannot perform the breast conserving surgery. In spite of its quite early breast cancer, we have to remove whole breast and it becomes to be excessive treatment. We use endoscopic procedure without removing nipple and skin. We perform skin-sparing total mastectomy + simultaneous breast reconstruction. We use silicon prosthesis. We do not harm the other place of the body. The breast symmetry will be kept.

Introduction of the hospital