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.
Objective To evaluate the aesthetic outcomes and safety of titanium-coated polypropylene mesh (TCPM) in immediate implant-based breast reconstruction (IBBR) following single-axillary approach endoscopic nipple-sparing mastectomy (NSM), and to provide references for the clinical application of synthetic meshes. Methods A retrospective analysis was conducted on 173 female patients who underwent immediate IBBR following single-axillary approach endoscopic NSM between May 2020 and June 2024. Patients were divided into a non-mesh group (n=100) and a mesh group (n=73) based on TCPM utilization. Baseline data, including body mass index (BMI), smoking history, alcohol consumption history, diabetes mellitus, hypertension, menstrual status, and postoperative radiotherapy, chemotherapy, and endocrine therapy, showed no significant differences between the two groups (P>0.05), whereas patients in the mesh group were significantly older than those in the non-mesh group (P<0.05). Postoperative complications, capsular contracture (Baker grading), prosthesis texture, aesthetic outcomes (modified Ueda score), and patient satisfaction [evaluated via the Breast Reconstruction Patient-Reported Outcome Scale (BREAST-Q)] were compared between the two groups. Ordinal logistic regression analysis was performed to identify independent factors influencing aesthetic outcomes. Results All patients were successfully followed up postoperatively. The follow-up duration was 30.50 (23.24, 40.04) months in the non-mesh group and 23.95 (18.52, 32.57) months in the mesh group, with no significant difference between the two groups (P>0.05). Regarding complications, no significant difference was observed between the two groups in the incidence of postoperative fever, upper limb lymphedema, seroma, wound dehiscence, operative site hemorrhage, or skin necrosis (P>0.05). However, the non-mesh group demonstrated significantly better outcomes than the mesh group in Baker grading for capsular contracture, implant texture, and aesthetic ratings (P<0.05). According to the postoperative BREAST-Q assessment, the non-mesh group scored higher in satisfaction with the reconstruction outcome and satisfaction with the surgeon (P<0.05). No significant difference was noted between the groups regarding psychosocial well-being, sexual health, breast appearance, implant contour, satisfaction with chest recovery, or satisfaction with the medical team (P>0.05). Univariate ordinal logistic regression analysis revealed that menstrual status, mesh usage, and postoperative radiotherapy, endocrine therapy, upper limb lymphedema were associated with breast aesthetic outcomes (P<0.05). Multivariate ordinal logistic regression analysis further confirmed that postoperative radiotherapy and mesh usage were independent risk factors for diminished aesthetic outcomes (P<0.05). Conclusion In immediate IBBR following single-axillary approach endoscopic NSM, omitting TCPM mesh superior aesthetic outcomes, a more natural breast texture, and a lower incidence of severe capsular contracture without increasing the risk of complications. Therefore, the routine application of TCPM in this specific surgical procedure warrants cautious consideration.
ObjectiveTo preliminarily compare the aesthetic outcomes, complication risks, and safety between endoscopic nipple-sparing mastectomy (E-NSM) and conventional open mastectomy (COM). MethodsPatients who underwent E-NSM at Sichuan Cancer Hospital and West China Hospital of Sichuan University between January 2023 and October 2024 were consecutively enrolled as the endoscopic group. Patients who underwent COM at the two centers during the same period were enrolled as the open (control) group through 1:2 propensity score matching. The two groups were compared with respect to patient-reported aesthetic outcomes (BREAST-Q, SCAR-Q, and Harris scores), postoperative complication rates, and oncological safety events. ResultsAll enrolled patients were female. Forty-four patients were included in the endoscopic group and 84 in the open group, with mean ages of (50.3±9.2) years and (50.8±9.2) years, respectively. The median follow-up durations were 5.5 (2.0, 10.0) months in the endoscopic group and 5.0 (1.9, 11.0) months in the open group (P=0.912). Regarding postoperative BREAST-Q scores, the endoscopic group scored significantly higher than the open group in satisfaction with breasts [58.0 (53.0, 66.0) points vs. 44.0 (39.0, 53.0) points ], psychosocial well-being [(79.0±12.1) points vs. (71.0±10.0) points], sexual well-being [(41.8±4.8) points vs. (35.3±6.7) points], and chest function [50.0 (40.0, 55.0) points vs. 40.0 (36.0, 50.0) points] (all P<0.001). In terms of the Harris score, the proportions of patients rated as "fair" and "poor" were lower in the endoscopic group than those in the open group (P<0.001). Regarding SCAR-Q scores, the endoscopic group scored significantly better than the open group in the appearance, symptom, and psychosocial domains (P<0.001). There was no significant between-group difference in shoulder abduction range of motion (P=0.875), and the scar length was significantly shorter in the endoscopic group (P<0.001). No tumor recurrence or metastasis was observed in either group during follow-up. ConclusionFor female patients with breast cancer, E-NSM provides better short-term aesthetic outcomes than COM, and there is no significant difference in complication rates between the two procedures.