Single-Axillary-Incision Endoscopic-Assisted Hybrid Technique for Nipple-Sparing Mastectomy: Technique, Preliminary Results, and Patient-Reported Cosmetic Outcome from Preliminary 50 Procedures

• Published in: Annals of surgical oncology Vol. 25; no. 5; pp. 1340 - 1349
• Main Authors: Lai, Hung-Wen, Lin, Shih-Lung, Chen, Shou-Tung, Kuok, Ka-Man, Chen, Shu-Ling, Lin, Ya-Ling, Chen, Dar-Ren, Kuo, Shou-Jen
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2018; Springer Nature B.V
• Subjects: Adult; Axilla; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Carcinoma, Intraductal, Noninfiltrating - secondary; Carcinoma, Intraductal, Noninfiltrating - surgery; Data processing; Endoscopy; Endoscopy - adverse effects; Endoscopy - methods; Esthetics; Female; Humans; Invasiveness; Lymph nodes; Lymphatic Metastasis; Mammaplasty - adverse effects; Mastectomy; Mastectomy - adverse effects; Mastectomy - methods; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Morbidity; Nipples; Oncology; Operative Time; Organ Sparing Treatments; Patient Reported Outcome Measures; Patient satisfaction; Preliminary Data; Surgery; Surgical Oncology; Tumor Burden; Tumors; Wounds; Robotic Surgery Platform; Nipple-sparing Mastectomy (NSM); Immediate Breast Reconstruction (IBR); Single-incision Procedures; Breast Cancer
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6383-z

Background A new hybrid technique for single-axillary-incision endoscopic-assisted nipple-sparing mastectomy (E-NSM) was introduced. Preliminary results are reported. Methods Patients who received single-axillary-incision E-NSM from August 2013 to August 2017 were searched from a single institution. Data were analyzed to determine the effectiveness and oncologic safety of single-axillary-incision E-NSM. Patient-oriented cosmetic outcome report was also obtained. Results During the study period, a total of 50 E-NSM with single-incision procedures were performed in 41 female patients with breast cancer, including 11 (26.8%) patients with bilateral disease. Their mean age was 45.3 ± 8.4 years. The mean size of tumors encountered during the 50 single-incision E-NSM procedures was 2.3 ± 1.8 (0.1–7.3) cm for invasive tumors and 2.6 ± 1.7 (0.2–5.7) cm for carcinoma in situ lesions. Six (12%) of those tumors were multifocal/multicentric. Lymph node metastasis was found during 12% of the procedures. Forty-five (90%) received immediate breast reconstruction with gel implant. Mean operating time was 244.3 ± 82.8 min. The overall complication rate was 6%, and no total nipple necrosis or implant loss was observed. No locoregional recurrence or distant metastasis was found during mean follow-up of 21.6 months. About 94.4% of patients were satisfied with the postoperative scar location and wound length. All patients who responded would choose the same operation again. Conclusions The proposed single-axillary-incision endoscopic hybrid technique for nipple-sparing mastectomy was a safe procedure with low morbidity and associated with high patient satisfaction.