Ms. T.M, 37 years old, had been aware of multiple benign breast tumors for several years. Recently, she noticed one unusually large mass. After undergoing a biopsy, the result confirmed a benign phyllodes tumor. She shared: "I’ve had the desire to get breast augmentation for many years, but the presence of multiple tumors always made me afraid it would affect my health or lead to complications later on."
Ultrasound findings of the breast mass (right side)
Having researched many aesthetic clinics, the patient remained hesitant due to the particular nature of her case. She hoped to find a surgeon with expertise in both pathology and aesthetics. Upon a friend’s recommendation, she came to Master of Medicine – Dr. Ho Cao Vu, with the hope that he could perform both the excision of the phyllodes tumor and the breast implant placement in a single surgery.
After consultation, Dr. Vu assessed that the phyllodes tumor was quite large and had been growing rapidly within a short period of time. He advised complete excision of the mass, as it was likely to continue increasing in size. Ultrasound findings of the right breast mass from a general hospital: located at the 10 o’clock position, 2 cm from the nipple, hypoechoic structure measuring 39×23×34 mm, smooth margins, well-defined boundaries, parallel to the skin surface, with increased vascularity (suggestive of a phyllodes tumor).
En bloc excision of the phyllodes tumor using ultrasonic scalpel from the posterior side of the mammary gland
Step 1: Create the implant pocket through the inframammary fold using an ultrasonic scalpel
The ultrasonic scalpel, with its combined mechanism of cutting, coagulation, and sealing, when applied with point dissection technique, offers several advantages for the surgeon: it allows precise release of muscle, fascia, and fibrotic tissue during pocket formation. This technique ensures effective hemostasis, reduces fluid accumulation, and minimizes thermal injury to surrounding tissue — optimizing conditions for the subsequent step of phyllodes tumor excision.
Step 2: Excision of the phyllodes tumor through the implant pocket incision or at the tumor site on the breast
After creating the implant pocket, Dr. Vu evaluated that it would be feasible to proceed with excising the phyllodes tumor through the same inframammary incision, thereby avoiding a second incision for the patient. Using a next-generation ultrasonic scalpel, the entire phyllodes tumor was carefully dissected from the posterior aspect of the mammary gland. The excised tumor was relatively large and multilobulated, and was sent for histopathological analysis.
Step 3: Implant size selection
Ms. T expressed a desire for a sexy breast shape — full, firm, with enhanced upper pole projection. After tumor removal, Dr. Vu assessed the distribution of glandular tissue, degree of tissue aging and fibrosis, skin elasticity, and chest wall structure to select an implant with the appropriate size and projection.
The patient did not require a surgical drain or postoperative pain medication and was discharged 6 hours after surgery. She wore a compression garment as instructed and followed the standard follow-up schedule as in a routine breast augmentation case.
Phyllodes tumor excision through the implant pocket incision
Advantages of using an ultrasonic scalpel in phyllodes tumor excision
The use of ultrasonic scalpels in breast tumor excision surgery has been applied since around 2010, offering several benefits for postoperative recovery, including:
1. Effective hemostasis: The ultrasonic scalpel operates via cutting, coagulation, and sealing using ultrasonic energy, significantly reducing intraoperative and postoperative bleeding — particularly beneficial in tumors with rich vascularity.
Phyllodes tumor is a type of benign (non-cancerous) tumor located in the breast gland. It often grows rapidly.
2. Reduced damage to surrounding tissue: The heat generated is lower than that of electrocautery, minimizing tissue damage and lowering the risk of necrosis.
3. Shorter surgery time: The combination of cutting and coagulation functions helps reduce overall operative time.
4. Less postoperative pain: Minimal tissue trauma leads to less pain and faster recovery. In some cases, patients may not require pain medication after surgery.
5. Aesthetic incision: Precise cutting results in minimal scarring, which is especially important in breast surgery.
