Evaluating the impacts of previous breast surgery on surgical complications and aesthetic outcomes in reverse-sequence endoscopic-assisted nipple-sparing mastectomy with or without direct-to-implant breast reconstruction.

PURPOSE: The reverse-sequence endoscopic-assisted nipple-sparing mastectomy (R-E-NSM), with or without direct-to-implant breast reconstruction (DTI-BR), has become increasingly popular in China. This study aimed to evaluate whether previous breast surgery (PBS) affects surgical complications and aesthetic outcomes after R-E-NSM. METHODS: Clinical data of patients who underwent R-E-NSM at the Breast Center, West China Hospital, Sichuan University, between April 30, 2020, and April 30, 2025, were prospectively collected and analyzed. RESULTS: A total of 1081 patients were enrolled in the study. Among them, 89 had intraoperative breast surgery (IBS), 56 had short-term previous breast surgery (SPBS), 75 had long-term previous breast surgery (LPBS), and 861 had no previous breast surgery (NPBS). SPBS and IBS were not significantly associated with increased complication risk after multivariable adjustment (all P > 0.05). LPBS was significantly associated with lower odds of any complications (OR, 0.238; 95% CI, 0.089-0.633; P = 0.040), minor complications (OR, 0.304; 95% CI, 0.122-0.752; P = 0.010), and CDC ≥ 2 complications (OR, 0.333; 95% CI, 0.125-0.885; P = 0.027). BREAST-Q scores did not differ significantly among groups. Compared with the NPBS group, the SPBS group showed a statistically significant difference in Ueda scores at 3 months (P = 0.014). Oncologic outcomes did not differ significantly among the four groups (all P > 0.05). CONCLUSION: For patients with SPBS, implementing R-E-NSM warrants careful clinical evaluation due to potential safety concerns. Among patients with LPBS, current evidence indicates that incorporating R-E-NSM is not an independent risk factor and may be linked to a significantly lower incidence of complications.