7-step endoscopic nipple-sparing mastectomy with implant-based breast reconstruction: nipple sensation preservation and low complications.

Abstract

Background: Single-port endoscopic nipple-sparing mastectomy (E-NSM) with implant-based breast reconstruction (IBBR) represents a promising surgical technique. However, the surgical procedures are complex and lack standardized and systematic surgical protocols. The seven-step method was introduced as a means of simplifying the complex surgical procedures, with detailed descriptions provided of the key points and critical aspects of the surgery.

Methods: The medical records of patients who received single-port E-NSM with IBBR guided by the seven-step method from January 2022 to March 2024 were analyzed. The preliminary results were presented.

Results: A total of 65 patients were enrolled in the study, who received 93 procedures of single-port E-NSM with IBBR following the seven-step method. The mean age was 41.7 ± 8.2 years, and the mean body mass index (BMI) was 22.81 ± 3.5 kg/m². All patients had breasts of C cup size or smaller. One case required nipple-areola complex (NAC) removal due to tumor involvement, while no involvement of the surgical margins was detected. The mean operative time was 258.6 ± 71.2 min, and the mean intraoperative blood loss was 27.7 ± 20.5 ml. The overall complication rate was 8.6%, with six cases (6.5%) of nipple partial ischemia observed. No case experienced nipple necrosis. All reported complications were classified as minor. In Breast-Q "Satisfaction with Breasts" module, the mean score was 65.7 ± 18.0. The "physical well-being of chest" score was 73.9 ± 13.6. All four sensory types of the nipple-light touch, temperature, pressure, and pain-as well as erectile function, were preserved at favorable rates following the procedure. As of the last follow-up, no patients experienced local recurrence, distant metastasis, or mortality.

Conclusions: Single-port E-NSM with IBBR, guided by the seven-step method, is a safe and feasibility surgical approach. It is associated with a low complication rate, good cosmetic outcomes, and reasonable preservation of nipple sensation and erectile function. This technique appears particularly suitable for patients with breast sizes of C cup or smaller. The proposed seven-step method may provide a valuable framework for clinical practice and serve as a practical reference for peers, thereby contributing to the establishment of standardized and systematic surgical protocols.