Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Zhenqiang ^1,2 , CHEN Kai ² , ZHU Liling ² , ZENG Jianfeng ¹ , ZHOU Zhiping ¹ ,  LI Shunrong ²

1. Department of General Surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;
2. Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P.R.China;

Corresponding?author：

LI Shunrong, Email: lishr@mail.sysu.edu.cn

Keywords：

Breast cancer; nipple-sparing mastectomy; endoscopy; breast reconstruction

DOI：

10.7507/1002-1892.201804027

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Objective To introduce an surgical technique of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods Between January 2017 and February 2018, 15 female patients with breast cancer (stageⅠ in 5 cases and stage Ⅱ in 10 cases) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. They were 27-45 years old (mean, 37.5 years). The disease duration ranged from 1 to 24 months (mean, 8 months). The tumor located at the left breast in 8 cases and at the right breast in 7 cases. The diameter of tumor ranged from 1.5 to 3.0 cm (mean, 2.6 cm). The distance between tumor and nipple was 1.8-4.0 cm (mean, 2.3 cm). Results After operation, the nipple epidermal necrosis occurred in 1 case, and subcutaneous effusion in 1 case. No subcutaneous emphysema or skin flap necrosis occurred. Postoperative pathological examination showed that 1 case was nipple involvement and was treated with nipple resection. All patients were followed up 7-17 months (mean, 11 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 4 cases of excellent, 10 cases of good, and 1 case of poor. No tumor recurrence or metastasis occurred during follow-up. Conclusion It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction.

Citation： HUANG Zhenqiang, CHEN Kai, ZHU Liling, ZENG Jianfeng, ZHOU Zhiping, LI Shunrong. Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1458-1462. doi: 10.7507/1002-1892.201804027 Copy

1.	Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat, 2009, 118(3): 623-633.
2.	劉寶胤, 丁毅, 駱成玉, 等. 乳腔鏡輔助乳腺癌腺體切除假體植入一期成形 17 例報告. 中國現代手術學雜志, 2013, 17(2): 104-107.
3.	張敬, 鐘青, 趙長嘯, 等. 腔鏡輔助下乳暈區小切口皮下全乳腺體切除一期假體植入術. 徐州醫學院學報, 2013, 33(10): 673-675.
4.	范林軍, 姜軍, 楊新華, 等. 全腔鏡乳腺癌皮下腺體切除一期假體植入乳房重建. 中國微創外科雜志, 2008, 8(6): 484-487.
5.	楊華偉, 劉劍侖, 唐瑋, 等. 全腔鏡下保留乳頭乳暈皮下腺體切除術的臨床應用. 廣西醫科大學學報, 2013, 30(4): 600-602.
6.	王子函, 滕長勝, 葛智成, 等. 全腔鏡乳房皮下腺體切除術加腔鏡前哨淋巴結活檢術治療乳腺癌的臨床應用. 臨床和實驗醫學雜志, 2015, 14(15): 1297-1301.
7.	佘青, 李有懷, 程永剛, 等. 全腔鏡乳房皮下腺體切除術聯合腔鏡前哨淋巴結活檢術治療早中期乳腺癌的技巧探討. 川北醫學院學報, 2016, 31(5): 756-758.
8.	Ahn SJ, Woo TY, Lee DW, et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol, 2018, 44(8): 1170-1176.
9.	Carlson GW, Chu CK, Moyer HR, et al. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J, 2014, 20(1): 69-73.
10.	Ho WS, Ying SY, Chan AC. Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc, 2002, 16(2): 302-306.
11.	Lai HW, Wu HS, Chuang KL, et al. Endoscopy-assisted total mastectomy followed by immediate pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction: preliminary results of 48 patients. Surg Innov, 2015, 22(4): 382-389.
12.	Lai HW, Chen ST, Chen DR, et al. Current trends in and indications for endoscopy-assisted breast surgery for breast cancer: results from a six-year study conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group. PLoS ONE, 2016, 11(3): e0150310.
13.	蔡小勇, 晏益核, 潘孟. 常規腔鏡器械經腋窩入路行單孔乳房纖維腺瘤切除術 1 例報告. 腹腔鏡外科雜志, 2012, 17(2): 159-160.
14.	Tukenmez M, Ozden BC, Agcaoglu O, et al. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. Journal of Laparoscopic & Advanced Surgical Techniques, 2014, 24(2): 77-82.
15.	Rossi C, Mingozzi M, Curcio A, et al. Nipple areola complex sparing mastectomy. Gland Surg, 2015, 4(6): 528-540.
16.	Rusby JE, Brachtel EF, Taghian A, et al. George Peters Award. Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy. Am J Surg, 2007, 194(4): 433-437.
17.	Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.

1. Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat, 2009, 118(3): 623-633.
2. 劉寶胤, 丁毅, 駱成玉, 等. 乳腔鏡輔助乳腺癌腺體切除假體植入一期成形 17 例報告. 中國現代手術學雜志, 2013, 17(2): 104-107.
3. 張敬, 鐘青, 趙長嘯, 等. 腔鏡輔助下乳暈區小切口皮下全乳腺體切除一期假體植入術. 徐州醫學院學報, 2013, 33(10): 673-675.
4. 范林軍, 姜軍, 楊新華, 等. 全腔鏡乳腺癌皮下腺體切除一期假體植入乳房重建. 中國微創外科雜志, 2008, 8(6): 484-487.
5. 楊華偉, 劉劍侖, 唐瑋, 等. 全腔鏡下保留乳頭乳暈皮下腺體切除術的臨床應用. 廣西醫科大學學報, 2013, 30(4): 600-602.
6. 王子函, 滕長勝, 葛智成, 等. 全腔鏡乳房皮下腺體切除術加腔鏡前哨淋巴結活檢術治療乳腺癌的臨床應用. 臨床和實驗醫學雜志, 2015, 14(15): 1297-1301.
7. 佘青, 李有懷, 程永剛, 等. 全腔鏡乳房皮下腺體切除術聯合腔鏡前哨淋巴結活檢術治療早中期乳腺癌的技巧探討. 川北醫學院學報, 2016, 31(5): 756-758.
8. Ahn SJ, Woo TY, Lee DW, et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol, 2018, 44(8): 1170-1176.
9. Carlson GW, Chu CK, Moyer HR, et al. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J, 2014, 20(1): 69-73.
10. Ho WS, Ying SY, Chan AC. Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc, 2002, 16(2): 302-306.
11. Lai HW, Wu HS, Chuang KL, et al. Endoscopy-assisted total mastectomy followed by immediate pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction: preliminary results of 48 patients. Surg Innov, 2015, 22(4): 382-389.
12. Lai HW, Chen ST, Chen DR, et al. Current trends in and indications for endoscopy-assisted breast surgery for breast cancer: results from a six-year study conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group. PLoS ONE, 2016, 11(3): e0150310.
13. 蔡小勇, 晏益核, 潘孟. 常規腔鏡器械經腋窩入路行單孔乳房纖維腺瘤切除術 1 例報告. 腹腔鏡外科雜志, 2012, 17(2): 159-160.
14. Tukenmez M, Ozden BC, Agcaoglu O, et al. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. Journal of Laparoscopic & Advanced Surgical Techniques, 2014, 24(2): 77-82.
15. Rossi C, Mingozzi M, Curcio A, et al. Nipple areola complex sparing mastectomy. Gland Surg, 2015, 4(6): 528-540.
16. Rusby JE, Brachtel EF, Taghian A, et al. George Peters Award. Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy. Am J Surg, 2007, 194(4): 433-437.
17. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision

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