Exploring Minimally Invasive Surgery Options for Breast Tumors

Limitations of Minimally Invasive Surgery

Hello, Doctor.
I previously had a benign phyllodes tumor that was approximately 4 cm in size, which was surgically removed from my left breast.
Unfortunately, it has recurred, and upon examination, the current size is about 5 to 6 cm (ultrasound could not determine the tumor size).
The doctor suspects it may still be a phyllodes tumor and has recommended surgical excision.
However, removing an additional centimeter around the tumor would almost result in the complete removal of the breast.
This procedure would require general anesthesia, involve a larger incision, and may necessitate the placement of a drain.
I have some concerns regarding general anesthesia due to my health condition.
I would like to ask if a 6 cm tumor can be managed with local anesthesia like the previous 4 cm tumor? Besides the traditional larger incision surgery, are there any self-funded minimally invasive surgical options available? If minimally invasive surgery is an option, should I seek evaluation at a major hospital? Can a general clinic perform this procedure? Thank you for your response, Doctor.

Niming, 30~39 year old female. Ask Date: 2019/04/09

Dr. Yuan Tianmin reply Breast and Thyroid

The issue I am currently considering is not whether minimally invasive surgery can be performed, but rather that the tumor has recurred and grown larger.
After this excision, there is a possibility of recurrence again, which would render reconstruction surgery meaningless.
Therefore, it is recommended to observe for one to two years, and if there is no recurrence, then consider reconstruction.
This is not about the size of the tumor limiting the conditions for using minimally invasive surgery.

Reply Date: 2019/04/09

More Info

When considering minimally invasive surgery options for breast tumors, particularly in the context of a recurrent phyllodes tumor (leaf-like tumor) that has grown to approximately 5-6 cm, there are several important factors to consider.
Firstly, the size and nature of the tumor play a significant role in determining the surgical approach. Phyllodes tumors, while often benign, can exhibit aggressive behavior and have a tendency to recur. The fact that you have had a previous surgery for a 4 cm tumor and are now facing a larger one raises concerns about the potential for further recurrence. The recommendation for surgical excision is standard practice, especially when there is uncertainty regarding the tumor's characteristics.

Regarding the use of general anesthesia versus local anesthesia, larger tumors typically require general anesthesia due to the complexity and extent of the surgery. Local anesthesia may not provide adequate pain control or allow for the necessary surgical access, especially if the tumor is deep-seated or if there is a need for extensive excision. However, the decision ultimately depends on the surgeon's assessment and the specific circumstances of your case.

Minimally invasive surgical techniques, such as video-assisted thoracoscopic surgery (VATS) or other laparoscopic approaches, are generally more applicable to smaller tumors or those located in specific areas of the breast. For larger tumors like yours, traditional open surgery may still be the most effective option to ensure complete removal and to minimize the risk of recurrence. While there are advancements in minimally invasive techniques, they may not be suitable for all cases, particularly those involving larger or more complex tumors.

If you are considering minimally invasive options, it is advisable to consult with a specialized breast surgeon at a comprehensive cancer center or a large hospital that has experience with such procedures. These facilities are more likely to have the necessary resources and expertise to evaluate your specific situation and determine the best surgical approach. General clinics may not have the same level of experience with complex breast tumors and may not offer the latest minimally invasive techniques.

In terms of costs, some minimally invasive procedures may not be covered by insurance, especially if they are considered experimental or not standard practice for your specific type of tumor. It is essential to discuss the financial implications with your healthcare provider and insurance company.

In summary, while minimally invasive surgery is an appealing option, the size and nature of your tumor, along with your medical history and concerns about anesthesia, will significantly influence the surgical approach. Consulting with a specialized breast surgeon at a reputable institution will provide you with the best guidance tailored to your situation. It is crucial to weigh the benefits and risks of each option and to ensure that any surgical approach taken is in your best interest for both immediate treatment and long-term outcomes.

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