Clinical value and safety of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction as day surgery for breast cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Youxing ¹ , LONG Xiaoqing ¹ , ZHU Zhongjian ² ,  HUANG Mingjun ¹

1. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, P. R. China;
2. Breast Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

HUANG Mingjun, Email: hmj123123@126.com

Keywords：

Breast cancer; implant-based breast reconstruction; day surgery; clinical value; complications

DOI：

10.7507/1007-4848.202503016

Video：

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Objective To investigate the feasibility, safety, and clinical value of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction performed as day surgery for breast cancer, aiming to provide a reference for major hospitals seeking to implement a day surgery model for breast cancer treatment. Methods We retrospectively analyzed 222 patients who underwent endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction for breast cancer at West China Hospital of Sichuan University from June 2021 to December 2022 were included, and were divided into a day surgery group and a conventional inpatient group based on their admission model. The operative indicators, Breast-Q scores, preoperative waiting time, length of hospital stay, hospitalization costs and complications of the two groups were analyzed. Results Except for intraoperative bleeding (P=0.007), the difference between the two groups in comparison of the rest of the operative indicators was not statistically significant (all P>0.05); there was no significant difference between the two groups in preoperative and postoperative Breast-Q scores (all P>0.05); the preoperative waiting time and length of stay in hospital of the day surgery group were 4.0 (3.0, 11.0) and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; except for postoperative pain scores (P<0.001), there was no statistically significant difference in complications between the two groups (all P>0.05).Conclusion Endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction in day surgery is feasible and safe.Without increasing postoperative complications, it effectively reduces hospitalization costs and shortens medical care time, demonstrating significant clinical value.

1.	郭丝锦, 樊菁, 张聚良, 等. 乳腺癌全麻日间手术管理模式的临床及社会价值. 中国医院管理, 2023, 43(4): 57-61.Guo SJ, Fan J, Zhang JL, et al. Clinical and social value of day surgery for breast cancer. Chin Hosp Manag, 2023, 43(4): 57-61.
2.	余煜, 姚燕丹. 腔镜在乳腺癌外科治疗应用的研究进展. 中山大学学报(医学科学版), 2024, 45(3): 361-369.Yu Y, Yao YD. Advances in endoscopic techniques for surgical management of breast cancer : a comprehensive review. J Sun Yat-sen Univ (Med Sci), 2024, 45(3): 361-369.
3.	Mennie J C, Mohanna P N, O'Donoghue J M, et al. National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study. Eur J Surg Oncol, 2017, 43(1): 52-61.
4.	Yang B, Ren G, Song E, et al. Current status and factors influencing surgical options for breast cancer in China: A nationwide cross-sectional survey of 110 hospitals. Oncologist, 2020, 25(10): 1473-1480.
5.	Xu F, Lei C, Cao H, et al. Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery: A survey based on 31 tertiary hospitals (CSBrS-004). Chin J Cancer Res, 2021, 33(1): 33-41.
6.	Gradishar W J, Moran M S, Abraham J, et al. Breast cancer, version 3. 2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(5): 331-357.
7.	郭宝良, 陈波, 张国强, 等. 中国乳腺癌术后即刻假体乳房重建手术临床实践指南(2023版). 中国实用外科杂志, 2023, 43(12): 1321-1327.Guo BL, Chen B, Zhang GQ, et al. Clinical practice China guidelines for implant-based immediate breast reconstruction following surgery of breast cancer(2023 edition). Chin J Pract Surg, 2023, 43(12): 1321-1327.
8.	Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
9.	嵇武, 刘亚萍, 戴玮. 我国日间手术开展现状与前景展望. 中国实用外科杂志, 2020, 40(2): 199-202.Ji W, Liu YP, Dai W. Current developments and future perspectives of ambulatory surgery in China. Chin J Pract Surg, 2020, 40(2): 199-202.
10.	Kim R, Kawai A, Wakisaka M, et al. Differences in immune response to anesthetics used for day surgery versus hospitalization surgery for breast cancer patients. Clin Transl Med, 2017, 6(1): 34.
11.	周娇, 梁法清, 谢妍妍, 等. 华西医院日间腔镜乳腺皮下切除联合一期假体重建的临床路径简介. 中国胸心血管外科临床杂志, 2021, 28(12): 1393-1399.Zhou J, Liang FQ, Xie YY, et al. A brief introduction to the clinical pathway of the endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy for breast cancer patients in day surgery center of West China Hospital. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(12): 1393-1399.
12.	Zhou J, 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-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
13.	黄明君, 梁鹏, 王煜, 等. 基于加速康复外科理念的日间四级手术围手术期管理的华西经验. 华西医学, 2024, 39(2): 295-299.Huang MJ, Liang P, Wang Y, et al. West China experience in perioperative management of fourth-level day surgery based on enhanced recovery after surgery concept. West China Med J, 2024, 39(2): 295-299.
14.	吕娇, 王倩, 王雅莉, 等. 癌症住院患者疼痛强度描述语的对应量化研究. 护理学杂志, 2024, 39(22): 68-71.Lu J, Wang Q, Wang YL, et al. Correspondence quantification study of pain intensity descriptors in cancer hospitalized patients. J Nurs Sci, 2024, 39(22): 68-71.
15.	谭冯丹, 杨焕佐, 曹晓蔓, 等. 腋窝入路逆序法腔镜乳腺癌保留乳头乳晕腺体切除术后全胸肌后假体乳房重建的单中心回顾性研究. 中国胸心血管外科临床杂志, 2025, 32(6): 785-791.Tan FD, Yang HZ, Cao XM, et al. Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction on breast cancer patients. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(6): 785-791.
16.	石立元, 张青月, 王小媛, 等. 中文版乳房重建术患者生活质量量表应用于假体置入乳房重建术后患者的信效度检验. 护士进修杂志, 2021, 36(9): 789-792.Shi LY, Zhang QY, Wang XY, et al. The reliability and validity of Chinese version Breast-Q 2. 0 among breast cancer patients underwent implant breast reconstruction. J Nurses Train, 2021, 36(9): 789-792.
17.	Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877.
18.	Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad356.
19.	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. Surg, 2023, 174(3): 464-472.
20.	谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路—华西医院经验分享. 外科理论与实践, 2022, 27(5): 396-402.Xie YY, Lu Q, Du ZG. Endoscopic and robotic breast surgery: present and future—the experience of West China Hospital. J Surg Concepts Pract, 2022, 27(5): 396-402.
21.	Rodriguez L V, Bloomstone J A. Benchmarking outcomes for day surgery. Best Pract Res Clin Anaesthesiol, 2023, 37(3): 331-342.
22.	俞德梁, 刘小南. 日间手术发展展望. 医学与哲学, 2022, 43(22): 61-64.Yu DL, Liu XN. Development prospect of ambulatory surgery. Med Philos, 2022, 43(22): 61-64.
23.	刘华英, 李玲, 史元湘, 等. ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究. 陆军军医大学学报, 2024, 46(14): 1658-1665.Liu HY, Li L, Shi YX, et al. Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery. J Army Med Univ, 2024, 46(14): 1658-1665.
24.	陈维, 黄明君, 戴燕. 多模式疼痛管理下日间手术患者术后疼痛的影响因素分析. 华西医学, 2022, 37(2): 208-213.Chen W, Huang MJ, Dai Y. Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management. West China Med J, 2022, 37(2): 208-213.
25.	中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识(2022年版). 中国癌症杂志, 2022, 32(9): 836-924.Committee of Breast Cancer Society, Chinese Anti-Cancer Association; Breast Surgeons Committee of Surgeons Branch, Chinese Medical Doctor Association; Committee of Breast Cancer Society, Shanghai Anti-Cancer Association. Expert consensus on oncoplastic surgery of breast tumor and breast reconstruction (2022 edition). China Oncol, 2022, 32(9): 836-924.
26.	王煜, 刘洋, 戴燕, 等. 以患者需求为导向构建围术期管理移动医疗手机应用软件. 护士进修杂志, 2020, 35(14): 1261-1265.Wang Y, Liu Y, Dai Y, et al. The construet the content and function of perioperative managementm-APP based on the needs of patients. J Nurses Train, 2020, 35(14): 1261-1265.
27.	戴燕, 黄明君. 日间手术护理管理的实践. 中国护理管理, 2021, 21(6): 951-956.Dai Y, Huang MJ. Management regulations of day surgery care. Chin Nurs Manag, 2021, 21(6): 951-956.

1. 郭丝锦, 樊菁, 张聚良, 等. 乳腺癌全麻日间手术管理模式的临床及社会价值. 中国医院管理, 2023, 43(4): 57-61.Guo SJ, Fan J, Zhang JL, et al. Clinical and social value of day surgery for breast cancer. Chin Hosp Manag, 2023, 43(4): 57-61.
2. 余煜, 姚燕丹. 腔镜在乳腺癌外科治疗应用的研究进展. 中山大学学报(医学科学版), 2024, 45(3): 361-369.Yu Y, Yao YD. Advances in endoscopic techniques for surgical management of breast cancer : a comprehensive review. J Sun Yat-sen Univ (Med Sci), 2024, 45(3): 361-369.
3. Mennie J C, Mohanna P N, O'Donoghue J M, et al. National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study. Eur J Surg Oncol, 2017, 43(1): 52-61.
4. Yang B, Ren G, Song E, et al. Current status and factors influencing surgical options for breast cancer in China: A nationwide cross-sectional survey of 110 hospitals. Oncologist, 2020, 25(10): 1473-1480.
5. Xu F, Lei C, Cao H, et al. Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery: A survey based on 31 tertiary hospitals (CSBrS-004). Chin J Cancer Res, 2021, 33(1): 33-41.
6. Gradishar W J, Moran M S, Abraham J, et al. Breast cancer, version 3. 2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(5): 331-357.
7. 郭宝良, 陈波, 张国强, 等. 中国乳腺癌术后即刻假体乳房重建手术临床实践指南(2023版). 中国实用外科杂志, 2023, 43(12): 1321-1327.Guo BL, Chen B, Zhang GQ, et al. Clinical practice China guidelines for implant-based immediate breast reconstruction following surgery of breast cancer(2023 edition). Chin J Pract Surg, 2023, 43(12): 1321-1327.
8. Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
9. 嵇武, 刘亚萍, 戴玮. 我国日间手术开展现状与前景展望. 中国实用外科杂志, 2020, 40(2): 199-202.Ji W, Liu YP, Dai W. Current developments and future perspectives of ambulatory surgery in China. Chin J Pract Surg, 2020, 40(2): 199-202.
10. Kim R, Kawai A, Wakisaka M, et al. Differences in immune response to anesthetics used for day surgery versus hospitalization surgery for breast cancer patients. Clin Transl Med, 2017, 6(1): 34.
11. 周娇, 梁法清, 谢妍妍, 等. 华西医院日间腔镜乳腺皮下切除联合一期假体重建的临床路径简介. 中国胸心血管外科临床杂志, 2021, 28(12): 1393-1399.Zhou J, Liang FQ, Xie YY, et al. A brief introduction to the clinical pathway of the endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy for breast cancer patients in day surgery center of West China Hospital. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(12): 1393-1399.
12. Zhou J, 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-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
13. 黄明君, 梁鹏, 王煜, 等. 基于加速康复外科理念的日间四级手术围手术期管理的华西经验. 华西医学, 2024, 39(2): 295-299.Huang MJ, Liang P, Wang Y, et al. West China experience in perioperative management of fourth-level day surgery based on enhanced recovery after surgery concept. West China Med J, 2024, 39(2): 295-299.
14. 吕娇, 王倩, 王雅莉, 等. 癌症住院患者疼痛强度描述语的对应量化研究. 护理学杂志, 2024, 39(22): 68-71.Lu J, Wang Q, Wang YL, et al. Correspondence quantification study of pain intensity descriptors in cancer hospitalized patients. J Nurs Sci, 2024, 39(22): 68-71.
15. 谭冯丹, 杨焕佐, 曹晓蔓, 等. 腋窝入路逆序法腔镜乳腺癌保留乳头乳晕腺体切除术后全胸肌后假体乳房重建的单中心回顾性研究. 中国胸心血管外科临床杂志, 2025, 32(6): 785-791.Tan FD, Yang HZ, Cao XM, et al. Clinical application of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction on breast cancer patients. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(6): 785-791.
16. 石立元, 张青月, 王小媛, 等. 中文版乳房重建术患者生活质量量表应用于假体置入乳房重建术后患者的信效度检验. 护士进修杂志, 2021, 36(9): 789-792.Shi LY, Zhang QY, Wang XY, et al. The reliability and validity of Chinese version Breast-Q 2. 0 among breast cancer patients underwent implant breast reconstruction. J Nurses Train, 2021, 36(9): 789-792.
17. Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877.
18. Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad356.
19. 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. Surg, 2023, 174(3): 464-472.
20. 谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路—华西医院经验分享. 外科理论与实践, 2022, 27(5): 396-402.Xie YY, Lu Q, Du ZG. Endoscopic and robotic breast surgery: present and future—the experience of West China Hospital. J Surg Concepts Pract, 2022, 27(5): 396-402.
21. Rodriguez L V, Bloomstone J A. Benchmarking outcomes for day surgery. Best Pract Res Clin Anaesthesiol, 2023, 37(3): 331-342.
22. 俞德梁, 刘小南. 日间手术发展展望. 医学与哲学, 2022, 43(22): 61-64.Yu DL, Liu XN. Development prospect of ambulatory surgery. Med Philos, 2022, 43(22): 61-64.
23. 刘华英, 李玲, 史元湘, 等. ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究. 陆军军医大学学报, 2024, 46(14): 1658-1665.Liu HY, Li L, Shi YX, et al. Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery. J Army Med Univ, 2024, 46(14): 1658-1665.
24. 陈维, 黄明君, 戴燕. 多模式疼痛管理下日间手术患者术后疼痛的影响因素分析. 华西医学, 2022, 37(2): 208-213.Chen W, Huang MJ, Dai Y. Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management. West China Med J, 2022, 37(2): 208-213.
25. 中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识(2022年版). 中国癌症杂志, 2022, 32(9): 836-924.Committee of Breast Cancer Society, Chinese Anti-Cancer Association; Breast Surgeons Committee of Surgeons Branch, Chinese Medical Doctor Association; Committee of Breast Cancer Society, Shanghai Anti-Cancer Association. Expert consensus on oncoplastic surgery of breast tumor and breast reconstruction (2022 edition). China Oncol, 2022, 32(9): 836-924.
26. 王煜, 刘洋, 戴燕, 等. 以患者需求为导向构建围术期管理移动医疗手机应用软件. 护士进修杂志, 2020, 35(14): 1261-1265.Wang Y, Liu Y, Dai Y, et al. The construet the content and function of perioperative managementm-APP based on the needs of patients. J Nurses Train, 2020, 35(14): 1261-1265.
27. 戴燕, 黄明君. 日间手术护理管理的实践. 中国护理管理, 2021, 21(6): 951-956.Dai Y, Huang MJ. Management regulations of day surgery care. Chin Nurs Manag, 2021, 21(6): 951-956.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesClinical value and safety of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction as day surgery for breast cancer

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