Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction in breast cancer patients: A retrospective single-center study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TAN Fengdan ¹ , YANG Huanzuo ² , CAO Xiaoman ¹ ,  DU Zhenggui ²

1. West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Breast Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

Breast cancer; endoscopy; breast reconstruction; reverse sequence method

DOI：

10.7507/1007-4848.202401080

Video：

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Objective To explore the clinical and aesthetic results of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction (IBBR) for breast cancer patients. Methods The clinical data of consecutive female patients who underwent single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral IBBR from May 2020 to December 2022 were retrospectively analyzed. The patient demographics, perioperative parameters, complications and aesthetic results were collected. Results A total of 62 patients (74 breasts) were included. The mean age of patients was (39.0±7.8) years. The total mean operation time was (185.2±45.5) minutes. Five (8.1%) patients suffered from surgical complications. Two (3.2%) patients experienced major complications, and 3 (4.8%) suffered from minor complications. No patient experienced partial nipple-areola complex necrosis. Seventeen (27.4%) patients experienced implant related complications, of which 11 (17.7%) experienced capsular contracture. During a median follow-up time of 30 months ranging from 11 to 42 months, no patient experienced locoregional recurrence, distant metastasis or death. Thirty-seven (88.1%) patients evaluated their breasts as good or excellent. In the surgeon-reported cosmetic results, 40 (95.2%) patients achieved excellent or good results. Conclusion This surgical technique is characterized by minimal trauma, short operation time, high safety, and excellent cosmetic outcomes for patients with small breasts and mild ptosis, making it worthy of further promotion.

Citation： TAN Fengdan, YANG Huanzuo, CAO Xiaoman, DU Zhenggui. Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction in breast cancer patients: A retrospective single-center study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(6): 785-791. doi: 10.7507/1007-4848.202401080 Copy

1.	Lovelace DL, McDaniel LR, Golden D. Long-term effects of breast cancer surgery, treatment, and survivor care. J Midwifery Womens Health, 2019, 64(6): 713-724.
2.	Dempsey K, Mathieu E, Brennan M, et al. Patient-reported health-related quality of life outcomes following mastectomy for breast cancer, with immediate, delayed or no breast reconstruction: Four-year follow-up from a prospective cohort study. Breast, 2023, 71: 122-131.
3.	胡滢, 唐鹏. 腔镜和机器人手术在乳腺癌外科应用进展. 中国实用外科杂志, 2020, 40(10): 1207-1209.Hu Y, Tang P. The application and development of endoscopic and robotic surgery for breast cancer. Chin J Pract Surg, 2020, 40(10): 1207-1209.
4.	Jiao Z, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: Medium-term oncological safety outcomes and feasibility of 24-hour discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
5.	Zhou J, Liu X, Feng Y, et al. Breakthrough in breast reconstruction in the context of COVID-19: Safety and efficiency of endoscopic breast reconstruction at a day surgery center. Gland Surg, 2021, 10(8): 2477-2489.
6.	刘馨然, 谢妍妍, 梁法清, 等. 腋窝入路腔镜下乳腺癌根治假体结合补片在一期乳房重建中的应用. 中国修复重建外科杂志, 2021, 35(9): 1212-1214.Liu XR, Xie YY, Liang FQ, et al. Endoscopic axillary approach for immediate breast reconstruction using implants and mesh following mastectomy in breast cancer patients. Chin J Repar Reconstr Surg, 2021, 35(9): 1212-1214.
7.	Ter Louw RP, Nahabedian MY. Prepectoral breast reconstruction. Plast Reconstr Surg, 2017, 140(5S Advances in Breast Reconstruction): 51S-59S.
8.	Yang H, Liang F, Xie Y, et al. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery, 2023, 174(3): 464-472.
9.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
10.	Spear SL, Baker JL. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg, 1995, 96(5): 1119-1123.
11.	Fitzal F, Krois W, Trischler H, et al. The use of a breast symmetry index for objective evaluation of breast cosmesis. Breast, 2007, 16(4): 429-435.
12.	Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery, 2008, 143(3): 414-425.
13.	Plachinski SJ, Boehm LM, Adamson KA, et al. Comparative analysis of prepectoral versus subpectoral implant-based breast reconstruction. Plast Reconstr Surg Glob Open, 2021, 9(7): e3709.
14.	Wan A, Liang Y, Chen L, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg, 2022, 157(12): e224711.
15.	O'Connell RL, Tasoulis MK, Hristova E, et al. Satisfaction with long-term aesthetic and 10 years oncologic outcome following risk-reducing mastectomy and implant-based breast reconstruction with or without nipple preservation. Cancers (Basel), 2022, 14(15): 3607.

1. Lovelace DL, McDaniel LR, Golden D. Long-term effects of breast cancer surgery, treatment, and survivor care. J Midwifery Womens Health, 2019, 64(6): 713-724.
2. Dempsey K, Mathieu E, Brennan M, et al. Patient-reported health-related quality of life outcomes following mastectomy for breast cancer, with immediate, delayed or no breast reconstruction: Four-year follow-up from a prospective cohort study. Breast, 2023, 71: 122-131.
3. 胡滢, 唐鹏. 腔镜和机器人手术在乳腺癌外科应用进展. 中国实用外科杂志, 2020, 40(10): 1207-1209.Hu Y, Tang P. The application and development of endoscopic and robotic surgery for breast cancer. Chin J Pract Surg, 2020, 40(10): 1207-1209.
4. Jiao Z, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: Medium-term oncological safety outcomes and feasibility of 24-hour discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
5. Zhou J, Liu X, Feng Y, et al. Breakthrough in breast reconstruction in the context of COVID-19: Safety and efficiency of endoscopic breast reconstruction at a day surgery center. Gland Surg, 2021, 10(8): 2477-2489.
6. 刘馨然, 谢妍妍, 梁法清, 等. 腋窝入路腔镜下乳腺癌根治假体结合补片在一期乳房重建中的应用. 中国修复重建外科杂志, 2021, 35(9): 1212-1214.Liu XR, Xie YY, Liang FQ, et al. Endoscopic axillary approach for immediate breast reconstruction using implants and mesh following mastectomy in breast cancer patients. Chin J Repar Reconstr Surg, 2021, 35(9): 1212-1214.
7. Ter Louw RP, Nahabedian MY. Prepectoral breast reconstruction. Plast Reconstr Surg, 2017, 140(5S Advances in Breast Reconstruction): 51S-59S.
8. Yang H, Liang F, Xie Y, et al. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery, 2023, 174(3): 464-472.
9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
10. Spear SL, Baker JL. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg, 1995, 96(5): 1119-1123.
11. Fitzal F, Krois W, Trischler H, et al. The use of a breast symmetry index for objective evaluation of breast cosmesis. Breast, 2007, 16(4): 429-435.
12. Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery, 2008, 143(3): 414-425.
13. Plachinski SJ, Boehm LM, Adamson KA, et al. Comparative analysis of prepectoral versus subpectoral implant-based breast reconstruction. Plast Reconstr Surg Glob Open, 2021, 9(7): e3709.
14. Wan A, Liang Y, Chen L, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg, 2022, 157(12): e224711.
15. O'Connell RL, Tasoulis MK, Hristova E, et al. Satisfaction with long-term aesthetic and 10 years oncologic outcome following risk-reducing mastectomy and implant-based breast reconstruction with or without nipple preservation. Cancers (Basel), 2022, 14(15): 3607.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction in breast cancer patients: A retrospective single-center study

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