X-shaped Breast Lift to Improve Surgical Ergonomics in Bilateral Axillo-Breast Approach Thyroidectomy

Background: Endoscopic thyroidectomy through the bilateral axillo-breast approach (BABA) is a good option for patients who have been advised thyroid resection but are concerned about the cosmetic results. This technique uses the breast tissue as a pivot to facilitate maneuvering of the surgical instruments. However, it is difficult to use this technique in patients with small breasts or having a flat chest. Materials and Methods: The authors developed an "X-shaped breast lift" method using fabric adhesive tape, to push up and augment the breast tissue to facilitate the thyroid dissection procedure. Changes before and after the breast lift were quantified by measuring the angle of breast tilt and the distance between relevant anatomic landmarks. Results: Fifteen consecutive patients underwent this procedure before undergoing BABA thyroidectomy. The mean breast tilt angle increased from 3.2 to 9.8 degrees, which is a >3-fold increase (+6.6 degree, 206%). The mean distance between the cricoid cartilage and nipple was reduced by 1.9 cm (-8%), and the mean distance between the axillary incision and nipple increased by 1.1 cm (9%). No skin trauma or ulceration was observed. Conclusions: X-shaped breast lift is easy to perform, and it significantly improves the thyroid dissection process with no significant adverse effects. It can be used for all cases of BABA thyroidectomy.