Recently, Ms. LIU received the endoscopic lumpectomy at SAHZU to remove a giant tumor in her breast. The surgery is the first of its kind in Zhejiang province.

Bride Finds Huge Lump before Wedding

Four months ago, during a physical health screening, 30-year-old Ms. LIU was told that she had a lump of 3 centimeters in her right breast near the areola. But she didn't pay much attention to it because she was too busy with her work at that time.

However, in recent days, she felt the lump was becoming bigger. Ms. LIU soon had an ultrasound examination and an enhanced MRI scan at a local hospital. The results shew that the lump, which has grown to 8 centimeters, was occupying her right breast and classified as BIRADS-4B with a 10-50% chance of malignancy.

Ms. LIU was immediately suggested to remove the lump surgically. She was told that, considering the size of the lump, a reconstruction surgery is needed to restore the shape of her breast after the resection, even if the lump is benign. Otherwise, her right breast would "collapse" in the center like a basin. Therefore, the incision site must be in the front of her breast. 

Ms. LIU and her fiancé were devasted by the surgery plan: a major surgery that would leave a 6-8 centimeter scar on the upper part of her breast? It not only means that Ms. LIU would never be able to wear low-necked tops, but her plan to take wedding photos next month would be affected too. Ms. LIU hesitated, then decided to look for other options.

Tiny Incision for the Sake of Her Wedding  

Ms. LIU found on the Internet that an advanced technique of endoscopic lumpectomy is offered at SAHZU, where the mastectomy and breast reconstruction could be performed micro-invasively from a 3-4 cm incision in the armpit. After reading this, Ms. LIU immediately came to SAHZU Breast Surgeon Dr. NI Chao’s clinic.

After a thorough consultation and a careful physical examination, the possibility of malignancy of the lump was ruled out by Dr. NI. But a surgery is still necessary as the lump was doubled in size within only 3 months. Ms. LIU talked to Dr. NI about her concerns: she hopes the bump could be fully removed as much as that the incision could be hidden in the armpit. After all, it is her sincere hope that she could complete her wedding ceremony being her best self.

Before addressing Ms. LIU's concerns, Dr. Ni first performed a biopsy for her, and the rapid pathology review confirmed that the lump was indeed a benign fibroadenoma. However, from the surgeon's point of view, the surgical treatment that Ms. LIU needs is even more complicated than a mastectomy for breast cancer, because the tumor in her body was so tough that it is difficult to hold it under the endoscope. The difficulties also lie in the preservation of normal breast tissue and areola duct so as to maintain her breastfeeding function, and the remodeling of the complete breast tissue under the endoscope so as to avoid the deformation of the breast after the tumor removal.

Dr. NI finally came up with the treatment plan that caters to Ms. LIU's demands: he would perform a trans-axillary gasless endoscopic lumpectomy, and reconstruct her breast to fill up the "basin" left after the tumor removal with her own breast tissue at the same time. In this way, Ms. LIU's breasts would become normal in shape again.

3cm Incision in the Aimpit

The surgery took Dr. NI Chao and Dr. SUN Shanshan for about one hour to remove the huge lump and remodel the breast tissue. An incision of only 3cm was left in Ms. LIU's armpit after the surgery, which can be completely covered when she puts down her arm. Ms. LIU was discharged the next morning after the surgery.

Innovation of Surgery Approach and Technique

Breast fibroadenoma is the most common type of benign breast tumor often seen on females between ages 15 and 35. Most breast fibroadenoma grow slowly or even don’t change at all; only a few grow rapidly within a short period of time. The risk of fibroadenoma developing into breast cancer is as low as 0.12%-0.30%, but patients with atypical hyperplasia, a family history of breast cancer in first-degree relatives or complex fibroadenomas have a significantly higher risk of breast cancer than those with ordinary fibroadenomas. If the lump is found to be growing rapidly during the follow-up, it is recommended to have surgical management if any of the following criteria being met:

1) The maximum diameter of the tumor is increased by more than 20% within 6 months;

2) The maximum tumor diameter is increased by 16% or more per month in patients under age 50;

3) The maximum tumor diameter is increased by 13% or more per month in patients above age 50.

Endoscopic Lumpectomy 

Endoscopic lumpectomy with a gasless axillary approach is a minimally invasive technique developed by the Department of Breast Surgery, one of the distinguished clinical specialties at SAHZU. The academic director of the department Prof. HUANG Jian and Dr. NI Chao have co-applied for and obtained two related patents. They have completed nearly one hundred surgeries using the gasless axillary approach, for the resection of benign and malignant tumor, breast reconstruction with prosthesis, management of gynecomastia, and breast implants removal and reconstruction. The Department of Breast Surgery at SAHZU is leading in Zhejiang Province in terms of the volume of this kind of minimally invasive surgery.