Endoscope-Assisted Nipple-Sparing Mastectomy With Immediate Implant Reconstruction: A Retrospective Study.

Abstract

Breast cancer surgery increasingly favors nipple-sparing and endoscopic techniques to optimize oncological safety, cosmetic outcomes, and patient satisfaction. We aimed to evaluate and compare the clinical efficacy and postoperative safety profiles of endoscope-assisted and conventional open approaches for nipple-sparing mastectomy with immediate prosthetic reconstruction in breast carcinoma management. This retrospective study evaluated 75 consecutive patients undergoing nipple-sparing mastectomy with concurrent prosthetic reconstruction at a tertiary referral center (Hanzhong Central Hospital) between December 2021 and December 2023. Patients were allocated into two groups based on the surgical modality: endoscope-assisted (n = 35) versus conventional open (n = 40) approaches based primarily on patient preference and secondarily on surgeon selection. In cases of significant comorbidities, conventional open mastectomy (or state type) was performed. We observed significant differences in procedural characteristics between the endoscope-assisted and conventional open surgery cohorts. The endoscopic cohort had a 23.5% prolongation in operative duration, with a 64% reduction in total incision length. No significant differences were observed between the groups in critical clinical outcomes, including intraoperative hemostasis parameters, postoperative drainage volumes, complication profiles, or oncological safety markers. Implant removal was required in one patient in each group. Patient-reported outcome measures showed equivalence in BREAST-Q domains assessing chest wall integrity, psychosocial adaptation, and sexual well-being, along with comparable Harris functional assessment scores. The endoscopic approach yielded superior scar cosmesis as quantified using the SCAR-Q evaluation. Endoscope-assisted nipple-sparing mastectomy with immediate prosthetic reconstruction is not inferior to conventional open techniques regarding perioperative safety, oncological radicality, and multidimensional patient satisfaction metrics. This approach provides enhanced aesthetic outcomes through minimized cutaneous trauma.