A retrospective cohort study of endoscopic surgery and open surgery in nipple-sparing mastectomy with immediate reconstruction for breast cancer
WANG Yidi
ZI Haoyi
DING Jiajun
MENG Huimin
LI Mengxuan
KONG Jing
LI Songpeng
FAN Jing
LI Nanlin
ZHANG Juliang
WANG Ting
Abstract：Objective To explore the efficacy and safety of endoscopic nipple-sparing mastectomy(E-NSM)with immediate reconstruction for breast cancer.Methods This study retrospectively investigated 257 patients who underwent nipple-sparing mastectomy at the Department of Thyroid,Breast and Vascular Surgery,Xijing Hospital,Air Force Medical University from January 1,2019 to December 31,2022.Among them,142 patients received conventional open surgery,while 115 patients received endoscopic-assisted surgery.The clinical data of these patients were retrospectively analyzed,including pathological characteristics,surgical procedures,operative time,prosthesis size,flap necrosis,and postoperative infection rates.The BREAST-Q 2.0 questionnaire was used to assess patient satisfaction and quality of life.Results No statistically significant difference was observed in operative time between the conventional nipple-sparing mastectomy group(C-NSM group)and E-NSM group[130(110,170)minvs 135(110,175)min,P=0.232 9].However,the C-NSM group had significantly larger implant compared to the E-NSM group[(236.78±47.36)mL vs(218.52±50.52)mL,P=0.003 8].The median follow-up duration was significantly longer in the C-NSM group than that in the E-NSM group[48(32,58)months vs 32(26,40)months,P＜0.000 1].During postoperative follow-up,although the C-NSM group exhibited a higher number of implant loss compared to the E-NSM group[9 cases(6.34％)vs 2 cases(1.74％)],the difference between the two groups was not statistically significant(P＞0.05).In terms of short-term postoperative complications,including hemorrhage,flap ischemia,nipple-areola complex ischemia,and infection,the C-NSM group demonstrated a significantly higher complication rate compared to the E-NSM group,with statistically significant difference(P＜0.05).At the final follow-up,the E-NSM group demonstrated superior BREAST-Q 2.0 scores in breast satisfaction,psychosocial well-being,and chest pain compared to the C-NSM group,with statistically significant difference(P＜0.05).During the long-term postoperative follow-up period,3 patients in the C-NSM group and 2 patients in the E-NSM group experienced local recurrence,and only one case of distant metastasis was observed in the C-NSM group.In terms of endoscopic operations,the operative time was analyzed,and it was found that the learning curve gradually shortened with the accumulation of surgical experience and case numbers over time.Conclusion E-NSM causes less damage compared with traditional open surgery,and the operative time is not prolonged,with fewer postoperative complications,superior aesthetic outcomes,and short learning curve,demonstrating promising clinical application potential.
Keywords：breast neoplasmsendoscopic surgeryconventional open surgeryprepectoral breast reconstructionsubpectoral breast reconstructionendoscopynecrosistreatment outcome
Publication Date：2025-09-30
Online Publishing Date：2026-08-26(First online date of this platform, not the publication date of the document)
Pages：10( 1133-1142 )