[Developments in minimally invasive breast surgery - overview and our own experience: new diagnostic and therapeutic challenges in breast cancer].

New diagnostic and therapeutic modalities in breast cancer are necessary because nowadays an increased number of suspicious breast lesions are referred to breast clinics for a histological diagnosis. In the future more than one quarter of patients might present with a preinvasive lesion and more than half of the patients will have tumors less than 2 cm. Mammography screening helps to find more preinvasive lesions. Therefore we need new tools for exact stereotactic breast biopsies in the outpatient setting, such as the advanced breast biopsy instrumentation (ABBI((R))) or the Mammotome((R)) system. For axillary clearance we need methods that lead to less morbidity. The detection of the sentinel lymph node is one of these new techniques. Endoscopic axillary clearance after liposuction also helps to reduce morbidity. Due to better visualization of the anatomic structures with axilloscopy less traumatic surgery is possible. We also combined these two new methods and described the endoscopic clearance of the sentinel lymph node in the axilla with the additional help of isosulfan blue. However, this combined method is not only time-consuming but also more expensive and shows no obvious advantage compared to the open sentinel technique. Therefore we stopped using the endoscopic sentinel technique and we now promote open sentinel lymph node biopsy without full axillary clearance when frozen section shows sentinel node-negative lymph nodes.