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. MethodsThe 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 patients 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. ConclusionThis 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.