Clinical Outcomes of Transaxillary Reverse-Sequence Endoscopic Nipple-Sparing Mastectomy and Direct-to-Implant Prepectoral Breast Reconstruction: A Prospective Study of Initial 68 Procedures

Clinical outcomes and aesthetic results of reverse sequence endoscopic versus traditional bilateral nipple-sparing mastectomy with immediate implant-based breast reconstruction-an analysis of initial 116 patients from single institution

Background

Endoscopic or robotic surgeries can minimize and hide the scars compared to conventional breast reconstruction but are considered unsuitable for bilateral procedures due to the extended operation time. This study explored a novel time-shortening endoscopic technique, namely reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with bilateral implant-based breast reconstruction (BIBR), and compared it with conventional open surgery in clinical and cosmetic outcomes.

Methods

We retrospectively analyzed patients who underwent BIBR in the West China Hospital from January 2017 to June 2022. Patient characteristics, operation time, postoperative complications, breast satisfaction, and Scar-Q scores were compared between endoscopic and conventional open groups.

Results

Among 116 patients, 76 underwent R-E-NSM with BIBRs (R-E-BIBR group), and 40 underwent conventional open BIBRs (C-O-BIBR group). The demographics and clinical data were similar primarily (P > 0.05). Compared with the C-O-BIBR group, the R-E-BIBR group had lower rates of total (32.5% versus 6.6%, P < 0.001), major (13.8% versus 2.0%, P < 0.001) and minor (23.8% versus 3.9%, P < 0.001) complications. The operation time between the two groups is not statistically significant (290.2 ± 95.2 mins versus 271.9 ± 95.3 mins, P = 0.327). The Harris scale scored breast satisfaction, and the excellent rate of the C-O-BIBR group was 32.5% while the R-E-BIBR group was 58.0% (P < 0.001). The mean Scar-Q scores were 35.17± 9.6 in the C-O-BIBR group and 81.32 ± 12.3 in the R-E-BIBR group, respectively (P < 0.001).

Conclusion

The innovative R-E-NSM with implant-based breast reconstruction makes up for the long operation time of previous endoscopic surgeries and has significant advantages in reducing complication rates and improving the cosmetic results of the postoperative breasts.

Level of Evidence

Level III, Retrospective study.

Safety and aesthetic outcomes of double purse-string suture nipple reconstruction in early breast cancer patients undergoing nipple resection and endoscopic skin-sparing mastectomy with breast reconstruction

Background

The current surgical methods for managing incisions after nipple excision in breast reconstruction patients are limited. However, double purse-string suture (DPS) shows promise in the treatment of nipple excision. This study aimed to investigate the safety and aesthetic outcomes of DPS nipple reconstruction in early breast cancer patients who underwent endoscopic skin-sparing mastectomy (E-SSM) and breast reconstruction.

Methods

We retrospectively analyzed the clinical data of 87 early breast cancer patients with nipple excision who underwent E-SSM with breast reconstruction. According to the suture methods of nipple incision, all patients were divided into the spindle suture (SS) group, single purse-string suture (SPS) group, and DPS group, with SS and SPS groups combined as the traditional suture (TS) group. Then, we compared the groups' differences in aesthetic outcomes, surgical safety, and oncological safety.

Results

A total of 87 patients with 88 breasts were enrolled in this study (SS n=17, SPS n=21, DPS n=50). Patients in the DPS group had significantly better nipple reconstruction satisfaction, Harris scale and any complications incidence than the TS group (all p <0.05). For nipple reconstruction satisfaction and any complication, the adjusted OR (95%CI) of the DPS group were 6.314(1.095-36.415) (p=0.039) and 0.124(0.018-0.863) (p=0.035) compared with the SS group. One patient in the SS group had vertebral metastases, and no recurrence, metastasis, or death has been observed in the other two groups during the follow-up period.

Conclusions

DPS is an effective and safe nipple reconstruction procedure for patients undergoing E-SSM with breast reconstruction, delivering excellent aesthetic outcomes.

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

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.