Evolution of Operative Methods in Japan

The first operation for a breast cancer patient was performed in the early nineteenth century in Wakayama (1804.11.14), Japan. This operation was performed by Seishu Hanaoka, a Japanese doctor, using general anesthesia [1]. The general anesthetic agent used was called Tsusen-san, which was an extract of Datura metel. This might have been the first breast cancer operation under general anesthesia in the world. After that, no further descriptions of the operative method for breast cancer patients were given in Japan. The trends in the operative method for breast cancer in the modern era are about the same in Japan as in Western countries, but in Japan, the changes tend to occur more slowly. Notably, however, Shimada et al. reported the 5-year results of total mastectomy with axillary dissection compared to Halsted’s mastectomy as early as 1964 [2]. Their comparison showed no difference between the two methods; however, this method did not become popular in Japan at that time. According to the breast cancer registry of the Japanese Breast Cancer Society (JBCS) (Fig. 2.1) [3], standard radical mastectomy (Halsted’s mastectomy), which consisted of total mastectomy with major and minor pectoral muscle resection and axillary dissection, was the most popular operative method until 1980. About 90% of the cases underwent standard radical mastectomy. Then, modified radical mastectomy, which consisted of total mastectomy with/without minor pectoral muscle resection and axillary dissection, became the most popular operative method during the 1990s. There were several variations of the modified radical mastectomy, including Patey’s modified radical mastectomy, Auchincloss’ modified radical