Minimally Invasive Breast Surgery

What is minimally invasive breast surgery?

Minimally invasive breast surgery (MIBS) encompasses a range of surgical and non-surgical procedures aimed at improving the physical, emotional, and quality of life impact of a breast cancer diagnosis. The more important goals of MIBS are to improve the outcome of breast cancer treatment by:

• Preserving or even improving breast appearance
• Minimizing short and long-term side effects of surgery
• Reducing treatment complications
• Expediting return to normal daily activities

Which minimally-invasive breast procedures does Dr. Holmes perform?

A leading expert in minimally-invasive breast surgery, Dr. Holmes provides an array of such procedures, including

• Hidden scar nipple-sparing mastectomy. This type of mastectomy is a nipple-sparing mastectomy procedure performed through a small incision hidden in the skin fold under the breast. Combined with immediate breast reconstruction, hidden scar nipple-sparing mastectomy results in a normal-looking if not improved breast with intact skin, nipple, and areola and no visible scar when the breast is viewed from the front.
• Lymph node-sparing surgery.Lymph node sparing surgery begins with avoiding lymph node surgery altogether in situations where removal of lymph nodes contributes very little to the patient’s overall care. Sentinel node biopsy may be used in selected patients with early-stage breast cancer. Patients with advanced disease requiring removal of multiple lymph nodes may undergo axillary reverse mapping. Axillary reverse mapping entails injecting blue dye into the nearby arm, which temporarily turns the arm lymph nodes blue in color to make it easier for Dr. Holmes to see and protect arm lymph nodes during breast cancer surgery.  Protection of arm nodes and lymph vessels preserves the drainage of lymph fluid from the arm, thereby preventing or reducing the risk of lymphedema. Lymphatico-venous bypass can also be performed to restore lymphatic drainage that might be interrupted during lymph node surgery.
• Cryoablation. This is a ground-breaking new tumor freezing treatment for breast cancer. Cryoablation is performed using a needle-like instrument that is inserted through the center of the cancer to permit its freezing to a cancer-killing temperature.  
• Oncoplastic surgery. Oncoplastic surgery combines breast cancer surgery with breast reduction or breast lifts of both breasts to improve breast appearance and symmetry.  It also includes esthetic scar placement and full thickness closure of the lumpectomy cavity to prevent indentations in the breast after lumpectomy.
• Targeted intraoperative radiotherapy (TARGIT). TARGeted Intraoperative radioTherapy (TARGIT) is a form of breast radiation that is administered as a single treatment at the time of lumpectomy to reduce the risk of cancer recurrence as well as the burden and side effects of radiation.

How does Dr. Holmes reduce side effects and improve recovery of breast surgery?

Dr. Holmes utilizes numerous tools and techniques to minimize pain and maximize recovery from breast surgery, including:

• Long-acting local anesthetics.Generous use of long-acting local anesthetics during general anesthesia provides extended control of postoperative pain and reduces the need for postoperative pain medication.  Epinephrine in the anesthetic solution reduces blood loss and bruising to promote wound healing.
• Nerve blocks. Regional nerve blocks at the time of general anesthesia greatly reduce the need for pain pills and speed up recovery. For patients undergoing mastectomy or axillary node dissection, before beginning surgery Dr. Holmes generally performs a pectoral nerve block to reduce pain after surgery.
• Long-acting anti-nausea medications. Postoperative nausea may be controlled with anti-nausea patches or medications started immediately before surgery.

For more information about minimally invasive breast surgery, visit Dr. Holmes’s YouTube Channel here.