Clinical value and safety of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction as day surgery for breast cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Youxing ¹ , LONG Xiaoqing ¹ , ZHU Zhongjian ² ,  HUANG Mingjun ¹

1. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, P. R. China;
2. Breast Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

HUANG Mingjun, Email: hmj123123@126.com

Keywords：

Breast cancer; implant-based breast reconstruction; day surgery; clinical value; complications

DOI：

10.7507/1007-4848.202503016

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the feasibility, safety, and clinical value of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction performed as day surgery for breast cancer, aiming to provide a reference for major hospitals seeking to implement a day surgery model for breast cancer treatment. Methods We retrospectively analyzed 222 patients who underwent endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction for breast cancer at West China Hospital of Sichuan University from June 2021 to December 2022 were included, and were divided into a day surgery group and a conventional inpatient group based on their admission model. The operative indicators, Breast-Q scores, preoperative waiting time, length of hospital stay, hospitalization costs and complications of the two groups were analyzed. Results Except for intraoperative bleeding (P=0.007), the difference between the two groups in comparison of the rest of the operative indicators was not statistically significant (all P>0.05); there was no significant difference between the two groups in preoperative and postoperative Breast-Q scores (all P>0.05); the preoperative waiting time and length of stay in hospital of the day surgery group were 4.0 (3.0, 11.0) and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; except for postoperative pain scores (P<0.001), there was no statistically significant difference in complications between the two groups (all P>0.05).Conclusion Endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction in day surgery is feasible and safe.Without increasing postoperative complications, it effectively reduces hospitalization costs and shortens medical care time, demonstrating significant clinical value.

1.	郭絲錦, 樊菁, 張聚良, 等. 乳腺癌全麻日間手術管理模式的臨床及社會價值. 中國醫院管理, 2023, 43(4): 57-61.Guo SJ, Fan J, Zhang JL, et al. Clinical and social value of day surgery for breast cancer. Chin Hosp Manag, 2023, 43(4): 57-61.
2.	余煜, 姚燕丹. 腔鏡在乳腺癌外科治療應用的研究進展. 中山大學學報(醫學科學版), 2024, 45(3): 361-369.Yu Y, Yao YD. Advances in endoscopic techniques for surgical management of breast cancer : a comprehensive review. J Sun Yat-sen Univ (Med Sci), 2024, 45(3): 361-369.
3.	Mennie J C, Mohanna P N, O'Donoghue J M, et al. National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study. Eur J Surg Oncol, 2017, 43(1): 52-61.
4.	Yang B, Ren G, Song E, et al. Current status and factors influencing surgical options for breast cancer in China: A nationwide cross-sectional survey of 110 hospitals. Oncologist, 2020, 25(10): 1473-1480.
5.	Xu F, Lei C, Cao H, et al. Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery: A survey based on 31 tertiary hospitals (CSBrS-004). Chin J Cancer Res, 2021, 33(1): 33-41.
6.	Gradishar W J, Moran M S, Abraham J, et al. Breast cancer, version 3. 2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(5): 331-357.
7.	郭寶良, 陳波, 張國強, 等. 中國乳腺癌術后即刻假體乳房重建手術臨床實踐指南(2023版). 中國實用外科雜志, 2023, 43(12): 1321-1327.Guo BL, Chen B, Zhang GQ, et al. Clinical practice China guidelines for implant-based immediate breast reconstruction following surgery of breast cancer(2023 edition). Chin J Pract Surg, 2023, 43(12): 1321-1327.
8.	Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
9.	嵇武, 劉亞萍, 戴瑋. 我國日間手術開展現狀與前景展望. 中國實用外科雜志, 2020, 40(2): 199-202.Ji W, Liu YP, Dai W. Current developments and future perspectives of ambulatory surgery in China. Chin J Pract Surg, 2020, 40(2): 199-202.
10.	Kim R, Kawai A, Wakisaka M, et al. Differences in immune response to anesthetics used for day surgery versus hospitalization surgery for breast cancer patients. Clin Transl Med, 2017, 6(1): 34.
11.	周嬌, 梁法清, 謝妍妍, 等. 華西醫院日間腔鏡乳腺皮下切除聯合一期假體重建的臨床路徑簡介. 中國胸心血管外科臨床雜志, 2021, 28(12): 1393-1399.Zhou J, Liang FQ, Xie YY, et al. A brief introduction to the clinical pathway of the endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy for breast cancer patients in day surgery center of West China Hospital. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(12): 1393-1399.
12.	Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
13.	黃明君, 梁鵬, 王煜, 等. 基于加速康復外科理念的日間四級手術圍手術期管理的華西經驗. 華西醫學, 2024, 39(2): 295-299.Huang MJ, Liang P, Wang Y, et al. West China experience in perioperative management of fourth-level day surgery based on enhanced recovery after surgery concept. West China Med J, 2024, 39(2): 295-299.
14.	呂嬌, 王倩, 王雅莉, 等. 癌癥住院患者疼痛強度描述語的對應量化研究. 護理學雜志, 2024, 39(22): 68-71.Lu J, Wang Q, Wang YL, et al. Correspondence quantification study of pain intensity descriptors in cancer hospitalized patients. J Nurs Sci, 2024, 39(22): 68-71.
15.	譚馮丹, 楊煥佐, 曹曉蔓, 等. 腋窩入路逆序法腔鏡乳腺癌保留乳頭乳暈腺體切除術后全胸肌后假體乳房重建的單中心回顧性研究. 中國胸心血管外科臨床雜志, 2025, 32(6): 785-791.Tan FD, Yang HZ, Cao XM, et al. Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction on breast cancer patients. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(6): 785-791.
16.	石立元, 張青月, 王小媛, 等. 中文版乳房重建術患者生活質量量表應用于假體置入乳房重建術后患者的信效度檢驗. 護士進修雜志, 2021, 36(9): 789-792.Shi LY, Zhang QY, Wang XY, et al. The reliability and validity of Chinese version Breast-Q 2. 0 among breast cancer patients underwent implant breast reconstruction. J Nurses Train, 2021, 36(9): 789-792.
17.	Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877.
18.	Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad356.
19.	Yang H, Liang F, Xie Y, et al. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surg, 2023, 174(3): 464-472.
20.	謝妍妍, 呂青, 杜正貴. 乳腺腔鏡和機器人手術的現狀及未來之路—華西醫院經驗分享. 外科理論與實踐, 2022, 27(5): 396-402.Xie YY, Lu Q, Du ZG. Endoscopic and robotic breast surgery: present and future—the experience of West China Hospital. J Surg Concepts Pract, 2022, 27(5): 396-402.
21.	Rodriguez L V, Bloomstone J A. Benchmarking outcomes for day surgery. Best Pract Res Clin Anaesthesiol, 2023, 37(3): 331-342.
22.	俞德梁, 劉小南. 日間手術發展展望. 醫學與哲學, 2022, 43(22): 61-64.Yu DL, Liu XN. Development prospect of ambulatory surgery. Med Philos, 2022, 43(22): 61-64.
23.	劉華英, 李玲, 史元湘, 等. ERAS理念下日間手術管理模式在婦科腹腔鏡手術患者中的安全性及可行性研究. 陸軍軍醫大學學報, 2024, 46(14): 1658-1665.Liu HY, Li L, Shi YX, et al. Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery. J Army Med Univ, 2024, 46(14): 1658-1665.
24.	陳維, 黃明君, 戴燕. 多模式疼痛管理下日間手術患者術后疼痛的影響因素分析. 華西醫學, 2022, 37(2): 208-213.Chen W, Huang MJ, Dai Y. Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management. West China Med J, 2022, 37(2): 208-213.
25.	中國抗癌協會乳腺癌專業委員會, 中國醫師協會外科醫師分會乳腺外科醫師委員會, 上海市抗癌協會乳腺癌專業委員會. 乳腺腫瘤整形與乳房重建專家共識(2022年版). 中國癌癥雜志, 2022, 32(9): 836-924.Committee of Breast Cancer Society, Chinese Anti-Cancer Association; Breast Surgeons Committee of Surgeons Branch, Chinese Medical Doctor Association; Committee of Breast Cancer Society, Shanghai Anti-Cancer Association. Expert consensus on oncoplastic surgery of breast tumor and breast reconstruction (2022 edition). China Oncol, 2022, 32(9): 836-924.
26.	王煜, 劉洋, 戴燕, 等. 以患者需求為導向構建圍術期管理移動醫療手機應用軟件. 護士進修雜志, 2020, 35(14): 1261-1265.Wang Y, Liu Y, Dai Y, et al. The construet the content and function of perioperative managementm-APP based on the needs of patients. J Nurses Train, 2020, 35(14): 1261-1265.
27.	戴燕, 黃明君. 日間手術護理管理的實踐. 中國護理管理, 2021, 21(6): 951-956.Dai Y, Huang MJ. Management regulations of day surgery care. Chin Nurs Manag, 2021, 21(6): 951-956.

1. 郭絲錦, 樊菁, 張聚良, 等. 乳腺癌全麻日間手術管理模式的臨床及社會價值. 中國醫院管理, 2023, 43(4): 57-61.Guo SJ, Fan J, Zhang JL, et al. Clinical and social value of day surgery for breast cancer. Chin Hosp Manag, 2023, 43(4): 57-61.
2. 余煜, 姚燕丹. 腔鏡在乳腺癌外科治療應用的研究進展. 中山大學學報(醫學科學版), 2024, 45(3): 361-369.Yu Y, Yao YD. Advances in endoscopic techniques for surgical management of breast cancer : a comprehensive review. J Sun Yat-sen Univ (Med Sci), 2024, 45(3): 361-369.
3. Mennie J C, Mohanna P N, O'Donoghue J M, et al. National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study. Eur J Surg Oncol, 2017, 43(1): 52-61.
4. Yang B, Ren G, Song E, et al. Current status and factors influencing surgical options for breast cancer in China: A nationwide cross-sectional survey of 110 hospitals. Oncologist, 2020, 25(10): 1473-1480.
5. Xu F, Lei C, Cao H, et al. Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery: A survey based on 31 tertiary hospitals (CSBrS-004). Chin J Cancer Res, 2021, 33(1): 33-41.
6. Gradishar W J, Moran M S, Abraham J, et al. Breast cancer, version 3. 2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(5): 331-357.
7. 郭寶良, 陳波, 張國強, 等. 中國乳腺癌術后即刻假體乳房重建手術臨床實踐指南(2023版). 中國實用外科雜志, 2023, 43(12): 1321-1327.Guo BL, Chen B, Zhang GQ, et al. Clinical practice China guidelines for implant-based immediate breast reconstruction following surgery of breast cancer(2023 edition). Chin J Pract Surg, 2023, 43(12): 1321-1327.
8. Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
9. 嵇武, 劉亞萍, 戴瑋. 我國日間手術開展現狀與前景展望. 中國實用外科雜志, 2020, 40(2): 199-202.Ji W, Liu YP, Dai W. Current developments and future perspectives of ambulatory surgery in China. Chin J Pract Surg, 2020, 40(2): 199-202.
10. Kim R, Kawai A, Wakisaka M, et al. Differences in immune response to anesthetics used for day surgery versus hospitalization surgery for breast cancer patients. Clin Transl Med, 2017, 6(1): 34.
11. 周嬌, 梁法清, 謝妍妍, 等. 華西醫院日間腔鏡乳腺皮下切除聯合一期假體重建的臨床路徑簡介. 中國胸心血管外科臨床雜志, 2021, 28(12): 1393-1399.Zhou J, Liang FQ, Xie YY, et al. A brief introduction to the clinical pathway of the endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy for breast cancer patients in day surgery center of West China Hospital. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(12): 1393-1399.
12. Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
13. 黃明君, 梁鵬, 王煜, 等. 基于加速康復外科理念的日間四級手術圍手術期管理的華西經驗. 華西醫學, 2024, 39(2): 295-299.Huang MJ, Liang P, Wang Y, et al. West China experience in perioperative management of fourth-level day surgery based on enhanced recovery after surgery concept. West China Med J, 2024, 39(2): 295-299.
14. 呂嬌, 王倩, 王雅莉, 等. 癌癥住院患者疼痛強度描述語的對應量化研究. 護理學雜志, 2024, 39(22): 68-71.Lu J, Wang Q, Wang YL, et al. Correspondence quantification study of pain intensity descriptors in cancer hospitalized patients. J Nurs Sci, 2024, 39(22): 68-71.
15. 譚馮丹, 楊煥佐, 曹曉蔓, 等. 腋窩入路逆序法腔鏡乳腺癌保留乳頭乳暈腺體切除術后全胸肌后假體乳房重建的單中心回顧性研究. 中國胸心血管外科臨床雜志, 2025, 32(6): 785-791.Tan FD, Yang HZ, Cao XM, et al. Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction on breast cancer patients. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(6): 785-791.
16. 石立元, 張青月, 王小媛, 等. 中文版乳房重建術患者生活質量量表應用于假體置入乳房重建術后患者的信效度檢驗. 護士進修雜志, 2021, 36(9): 789-792.Shi LY, Zhang QY, Wang XY, et al. The reliability and validity of Chinese version Breast-Q 2. 0 among breast cancer patients underwent implant breast reconstruction. J Nurses Train, 2021, 36(9): 789-792.
17. Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877.
18. Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad356.
19. Yang H, Liang F, Xie Y, et al. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surg, 2023, 174(3): 464-472.
20. 謝妍妍, 呂青, 杜正貴. 乳腺腔鏡和機器人手術的現狀及未來之路—華西醫院經驗分享. 外科理論與實踐, 2022, 27(5): 396-402.Xie YY, Lu Q, Du ZG. Endoscopic and robotic breast surgery: present and future—the experience of West China Hospital. J Surg Concepts Pract, 2022, 27(5): 396-402.
21. Rodriguez L V, Bloomstone J A. Benchmarking outcomes for day surgery. Best Pract Res Clin Anaesthesiol, 2023, 37(3): 331-342.
22. 俞德梁, 劉小南. 日間手術發展展望. 醫學與哲學, 2022, 43(22): 61-64.Yu DL, Liu XN. Development prospect of ambulatory surgery. Med Philos, 2022, 43(22): 61-64.
23. 劉華英, 李玲, 史元湘, 等. ERAS理念下日間手術管理模式在婦科腹腔鏡手術患者中的安全性及可行性研究. 陸軍軍醫大學學報, 2024, 46(14): 1658-1665.Liu HY, Li L, Shi YX, et al. Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery. J Army Med Univ, 2024, 46(14): 1658-1665.
24. 陳維, 黃明君, 戴燕. 多模式疼痛管理下日間手術患者術后疼痛的影響因素分析. 華西醫學, 2022, 37(2): 208-213.Chen W, Huang MJ, Dai Y. Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management. West China Med J, 2022, 37(2): 208-213.
25. 中國抗癌協會乳腺癌專業委員會, 中國醫師協會外科醫師分會乳腺外科醫師委員會, 上海市抗癌協會乳腺癌專業委員會. 乳腺腫瘤整形與乳房重建專家共識(2022年版). 中國癌癥雜志, 2022, 32(9): 836-924.Committee of Breast Cancer Society, Chinese Anti-Cancer Association; Breast Surgeons Committee of Surgeons Branch, Chinese Medical Doctor Association; Committee of Breast Cancer Society, Shanghai Anti-Cancer Association. Expert consensus on oncoplastic surgery of breast tumor and breast reconstruction (2022 edition). China Oncol, 2022, 32(9): 836-924.
26. 王煜, 劉洋, 戴燕, 等. 以患者需求為導向構建圍術期管理移動醫療手機應用軟件. 護士進修雜志, 2020, 35(14): 1261-1265.Wang Y, Liu Y, Dai Y, et al. The construet the content and function of perioperative managementm-APP based on the needs of patients. J Nurses Train, 2020, 35(14): 1261-1265.
27. 戴燕, 黃明君. 日間手術護理管理的實踐. 中國護理管理, 2021, 21(6): 951-956.Dai Y, Huang MJ. Management regulations of day surgery care. Chin Nurs Manag, 2021, 21(6): 951-956.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesClinical value and safety of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction as day surgery for breast cancer

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