Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

Kawun Chung; Yanyan Xie; Faqing Liang; Mengxue Qiu; Huanzuo Yang; Qing Zhang; Hui Dai; Zhenggui Du

doi:10.3389/fonc.2024.1366877

Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

Front Oncol. 2024 Mar 6:14:1366877. doi: 10.3389/fonc.2024.1366877. eCollection 2024.

Authors

Kawun Chung^#^{1

2}, Yanyan Xie^#^{1

2}, Faqing Liang^#^{1

2}, Mengxue Qiu^{1

2}, Huanzuo Yang^{1

2}, Qing Zhang^{1

2}, Hui Dai^{1

2}, Zhenggui Du^{1

2}

Affiliations

¹ Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
² Breast Center, West China Hospital, Sichuan University, Chengdu, China.

^# Contributed equally.

Abstract

Background: Our center proposes a new technique that effectively provides space to broaden the surgical field of view and overcomes the limitations of endoscopy-assisted nipple-sparing mastectomy (E-NSM) by changing the dissection sequence and combining it with air inflation. The purpose of this study was to compare the clinical outcomes of the new technique designated "reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with subpectoral breast reconstruction (SBR)" and the conventional E-NSM (C-E-NSM) with SBR.

Method: All patients undergoing E-NSM with SBR at our breast center between April 2017 and December 2022 were included in this study. The cohort was divided into the C-E-NSM group and the R-E-NSM group. The operation time, anesthesia time, medical cost, complications, cosmetic outcomes, and oncological safety were compared.

Results: Twenty-six and seventy-nine consecutive patients were included in the C-E-NSM and R-E-NSM groups, with average ages of 36.9 ± 7.0 years and 39.7 ± 8.4 years (P=0.128). Patients in the R-E-NSM group had significantly shorter operation time (204.6 ± 59.2 vs. 318.9 ± 75.5 minutes, p<0.001) and anesthesia time (279.4 ± 83.9 vs. 408.9 ± 87.4 minutes, p<0.001) and decreased medical costs [5063.4 (4439.6-6532.3) vs. 6404.2 (5152.5-7981.5), USD, p=0.001] and increase SCAR-Q scores (77.2 ± 17.1 vs. 68.8 ± 8.7, P=0.002) compared to the C-E-NSM group. Although trends increased in both the excellent rate of Ueda scores (53.8% vs. 42.3%, P = 0.144), excellent rate of Harris scores (44.0% vs. 63.1%, P=0.102), and decreased surgical complications (7.6% vs. 19.2%, P = 0.135) were observed in the R-E-NSM group, the differences were not significant. There were no significant differences in oncological outcomes between the two groups.

Conclusion: R-E-NSM improves cosmetic outcomes and efficiency of C-E-NSM, reduces medical costs, and has a trend of lower surgical complications while maintaining the safety of oncology. It is a safe and feasible option for oncological procedures that deserves to be promoted and widely adopted in practice.

Keywords: C-E-NSM; HUAXI hole 1; R-E-NSM; complication; operation time.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by grants from the Key Projects of the Sichuan Provincial Health Commission (21PJ042), the Incubation Project of West China Hospital of Sichuan University (2022HXFH004), and the Natural Science Foundation of Sichuan Province (22NSFSC2361).