Endoscopic nipple-sparing mastectomy with immediate breast reconstruction and sentinel lymph node biopsy for early-stage breast cancer: a prospective case series.

BACKGROUND: Minimally invasive breast reconstruction is a surgical approach in contemporary breast cancer management that not only restores the breast following nipple-sparing mastectomy but also improves aesthetic outcomes through smaller incisions, reduces postoperative pain, and shortens hospital stay, thereby improving clinical outcomes. Breast reconstruction using submuscular implants or latissimus dorsi (LD) flaps via a transaxillary approach is a feasible technique that is increasingly adopted in contemporary surgical practice. Following 19 months of clinical experience, we report an endoscopic nipple-sparing mastectomy (E-NSM) technique. When combined with submuscular implants or LD flaps, this approach may be suitable for young patients with minimal ptosis or those undergoing bilateral procedures. E-NSM technique aims to optimize aesthetic symmetry for unilateral or bilateral breast reconstruction. METHODS: This study reports a case series of patients with early-stage breast cancer treated with E-NSM and immediate reconstruction using submuscular implants with polypropylene mesh reinforcement or LD flaps coverage. The study was conducted at the Department of Breast, Cho Ray Hospital. Patients were enrolled between January 2023 and July 2024, with follow-up continuing through March 2026. RESULTS: A total of 130 patients with early-stage breast cancer were enrolled, with a mean age of 44.9±6.3 years (range, 30-63). The distribution of clinical stages in the study population was as follows: 27/130 (20.8%) stage 0 cases (including 26 cTis and 1 ycT0), 47/130 (36.1%) cT1N0, 31/130 (23.8%) cT2N0, 7/130 (5.4%) cT1N1, 14/130 (10.8%) cT2N1, and 4/130 (3.1%) cT3N0. Neoadjuvant chemotherapy was administered to 23/130 patients (17.7%). Implant-based breast reconstruction was performed in 15.4% of cases, and the latissimus dorsi flap in 84.6%. Mean operative time was 209.0±16.5 minutes. Surgical outcomes were generally favorable. Postoperative nipple ischemia occurred in two cases (1.5%), both of which resolved after two weeks of follow-up, with no other complications identified. Patients reported minimal postoperative pain and high satisfaction with the reconstructed breasts. All patients were managed through a multidisciplinary team approach and were followed for a mean duration of 32 months (range, 20-38 months). No local recurrence or distant metastasis was observed during the follow-up period. CONCLUSIONS: In this study, E-NSM combined with sentinel lymph node biopsy and immediate breast reconstruction proved to be a feasible approach, offering favorable cosmetic outcomes. By potentially reducing the physical and psychological impact associated with traditional mastectomy, this technique may contribute to improved patient quality of life. Endoscopic surgery is associated with minimal scarring, reduced postoperative pain, and shorter hospital stays, which may facilitate early recovery and improve therapeutic outcomes in breast cancer management. Patient-reported outcomes suggested consistently high levels of patient satisfaction with the reconstructed breast contour.